Staci Stewart Holloway, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT 21756 Issued in CA

Practice address

2895 Loma Vista Rd
Ste B
Ventura, CA 93003-1572

Phone

(805) 643-4093

Fax

(805) 643-8401

NPI assigned

May 18, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Staci Stewart Graham Former name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Second Wave Physical Therapy IncGroup PAC ID 3274996905, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Second Wave Physical Therapy Inc.

  • Physical Therapy Clinic/Center
  • Oxnard, CA
  • NPI 1851082812

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Pacific Therapy Services, Inc

  • Physical Therapy Clinic/Center
  • Ventura, CA
  • NPI 1770665630

  Physical Therapist

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318291200000",
    "number": "1467687624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "363 S DOS CAMINOS AVE",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930034734",
            "telephone_number": "805-654-8544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2895 LOMA VISTA RD",
            "address_2": "STE B",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930031572",
            "telephone_number": "805-643-4093",
            "fax_number": "805-643-8401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLOWAY",
        "first_name": "STACI",
        "middle_name": "STEWART",
        "credential": "MPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-18",
        "last_updated": "2011-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 21756",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER ID",
            "identifier": "056608",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACI",
            "last_name": "GRAHAM",
            "middle_name": "STEWART",
            "credential": "MPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Austin Kyle Hollister
• Christopher Holloway, CERTIFIED ORTHOTIST
• Judith Ann Holloway, PH.D.
• Nneoma Holloway
• Sarah Kathleen Holloway
• Grenisha Holmes, LCSW
• Justin Holmes
• Sharon Holmgrain
• Pilar Maria Marguerite Holmstrom, PH.D.
• Douglas M Honeyman, PSYD

• Physical Therapist in Ventura, CA
• Providers in Ventura, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.