Stacy Rydbom

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

1655 Cane Bay Blvd Ste B
Summerville, SC 29486-2397

Phone

(843) 719-7473

Fax

(843) 279-3251

NPI assigned

Feb 1, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Rise Above Physical Therapy LLC

  • Physical Therapist
  • Summerville, SC
  • NPI 1366062127
  NPD Authorized official

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

{
    "created_epoch": "1548979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596412800000",
    "number": "1467917617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1655 CANE BAY BLVD STE B",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294862397",
            "telephone_number": "843-719-7473",
            "fax_number": "843-279-3251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 CANE BAY BLVD STE B",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294862397",
            "telephone_number": "843-719-7473",
            "fax_number": "843-279-3251"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 W 9th North St",
            "address_purpose": "LOCATION",
            "city": "Summerville",
            "state": "SC",
            "postal_code": "294836721",
            "country_code": "US",
            "telephone_number": "843-879-0922",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RYDBOM",
        "first_name": "STACY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-01",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica Russell, COTA/L
• Abbi Marie Russo, M.A.
• Iysis Chanel Rutledge
• Shanika Damien Rutledge, M.D.
• Ashley Karen Ryan, FNP
• Hagar Saad
• Nadia Sabeh Ayon
• Emma Saber, PA-C
• Jacqueline Christine Sadlon, LPC
• Safe Harbor Behavioral Health LLC

• Physical Therapy Assistant in Summerville, SC
• Providers in Summerville, SC by specialty
• Physical Therapy Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.