Stacy Ann Kennelly, MA PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

6496024 Issued in WI

Practice address

1612 N 37TH Street
Superior, WI 54880

Phone

(715) 392-5144

NPI assigned

Jun 6, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Stacy Ann Stanek Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528261989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2877 NORTHERN DRIVE",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "54880",
            "telephone_number": "715-392-4965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1612 N 37TH STREET",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "54880",
            "telephone_number": "715-392-5144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNELLY",
        "first_name": "STACY",
        "middle_name": "ANN",
        "credential": "MA PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "6496024",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "5371",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40382400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "STANEK",
            "middle_name": "ANN",
            "credential": "MA PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Travis Joseph Kasper, MD
• Daniel Michael Kearns
• Karsyn Lynn Keepers
• Deanna Sue Kelly, PTA
• Nicole Kelly
• Tristan Kerfeld
• Jason Kerska, PHARM. D
• Jon M Kiehl, HIS
• Kim Lagro Counseling Services,LLC
• Kintop Inc

• Physical Therapist in Superior, WI
• Providers in Superior, WI by specialty
• Physical Therapist in Wisconsin

• 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.