Stacie Michelle Willoughby

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

1922 Issued in SC

Practice address

2880 Tricom St Ste B
North Charleston, SC 29406-9171

Phone

(843) 553-6343

Fax

(843) 553-6404

NPI assigned

Nov 20, 2006

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

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528132347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "182 ANTEBELLUM WAY",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294838147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2880 TRICOM ST STE B",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069171",
            "telephone_number": "843-553-6343",
            "fax_number": "843-553-6404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLOUGHBY",
        "first_name": "STACIE",
        "middle_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "SC",
            "license": "1922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shamya Williams
• Alexa Richtmyer Williamson, D.M.D.
• Melissa Anne Williamson
• Jesse Michael Willingham, OD
• Laryssa Willis
• Tharyar Myatnoe Wilm
• Elizabeth Carr Wilson, RN
• Shacrisa Lashae Wilson
• Aziza Rahaman Win
• Angie Windham-Blanding

• Physical Therapy Assistant in North Charleston, SC
• Providers in North Charleston, 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 Jul 8, 2007; 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.