Staci Elmer, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

001901 Issued in WV

Practice address

907 Oak St
Kenova, WV 25530-1422

Phone

(304) 525-4460

Fax

(304) 529-7449

NPI assigned

Oct 12, 2021

Last updated

Oct 12, 2021By the provider in NPPES

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

Other names 1

• Staci Barada Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1633996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633996800000",
    "number": "1508528050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2240 5TH AVE",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257031239",
            "telephone_number": "304-525-4445",
            "fax_number": "304-529-7449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 OAK ST",
            "city": "KENOVA",
            "state": "WV",
            "postal_code": "255301422",
            "telephone_number": "304-525-4460",
            "fax_number": "304-529-7449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELMER",
        "first_name": "STACI",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-12",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WV",
            "license": "001901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACI",
            "last_name": "BARADA",
            "credential": "PTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapy Assistant in Kenova, WV
• Providers in Kenova, WV by specialty
• Physical Therapy Assistant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2021; 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.