Active NPI
Stacie Lee Haworth, M.P.T.
- Pediatric Physical Therapist
- Janesville, WI
National Provider Identifier
1528081007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 9823-024
- Practice address
- 1323 Creston Park Dr
Janesville, WI 53545-1126 - Phone
- (608) 756-9440
- NPI assigned
- Jul 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 9823-024 | WI | Primary |
Addresses
Primary practice location
1323 Creston Park Dr
Janesville, WI 53545-1126
Mailing address
4412 Touchstone Dr
Oneida, WI 54155-8662
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9823-024 | WI | MD | Pediatric Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Greenfield Rehab Agency Unc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Skilled Nursing Facility
- Kewaunee, WI
- NPI 1801006580
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222214400000",
"number": "1528081007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4412 TOUCHSTONE DR",
"city": "ONEIDA",
"state": "WI",
"postal_code": "541558662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1323 CRESTON PARK DR",
"city": "JANESVILLE",
"state": "WI",
"postal_code": "535451126",
"telephone_number": "608-756-9440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAWORTH",
"first_name": "STACIE",
"middle_name": "LEE",
"credential": "M.P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-25",
"last_updated": "2008-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "WI",
"license": "9823-024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Janesville, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.