Mary Jean Stack, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305212350 Issued in VA

Practice address

766 Walker Rd Ste B
Great Falls, VA 22066-2650

Phone

(202) 349-1030

Fax

(703) 364-5124

NPI assigned

Nov 17, 2014

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 2

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Group practices

Great Falls Physical Therapy LLCGroup PAC ID 6406286533, 8 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.

• Great Falls Physical Therapy LLC

  • Physical Therapist
  • Great Falls, VA
  • NPI 1497304976

  DC

  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1416182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780531200000",
    "number": "1508262734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "766 WALKER RD STE B",
            "city": "GREAT FALLS",
            "state": "VA",
            "postal_code": "220662650",
            "telephone_number": "202-349-1030",
            "fax_number": "703-364-5124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "766 WALKER RD STE B",
            "city": "GREAT FALLS",
            "state": "VA",
            "postal_code": "220662650",
            "telephone_number": "202-349-1030",
            "fax_number": "703-364-5124"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10135 Colvin Run Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Great Falls",
            "state": "VA",
            "postal_code": "220661872",
            "country_code": "US",
            "telephone_number": "703-349-1030",
            "fax_number": "703-364-5124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STACK",
        "first_name": "MARY JEAN",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-11-17",
        "last_updated": "2026-06-04",
        "certification_date": "2026-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305212350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1508262734",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PT872017",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Thomas Stormer, D.P.T.
• Hediyeh Tabibian, MSPT
• Saghi Tehran, PMHN NP

• Physical Therapist in Great Falls, VA
• Providers in Great Falls, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2026; 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.