Individual provider Active NPI

Kristen Stauber, DPT

  • Pediatric Physical Therapist
  • Arnold, MO
National Provider Identifier
1598052409
Registry record updated Jul 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
2013015514 Issued in MO
Practice address
3488 Jeffco Blvd
Suite 102
Arnold, MO 63010-6015
Phone
(636) 464-5439
Fax
(636) 464-5438
NPI assigned
Jun 30, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X 2013015514 MO Primary

Addresses

Primary practice location

3488 Jeffco Blvd
Suite 102
Arnold, MO 63010-6015

Mailing address

3488 Jeffco Blvd
Suite 102
Arnold, MO 63010-6015
Phone (636) 464-5439

Other identifiers 1

IdentifierTypeStateIssuer
47065477701MedicaidNE

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
3020NEMDMental Health Counselor
2013015514MOMDPediatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Procare3, Inc. PastSince Mar 13, 2006 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.

NPI Registry JSON

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

{
    "created_epoch": "1309392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374710400000",
    "number": "1598052409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3488 JEFFCO BLVD",
            "address_2": "SUITE 102",
            "city": "ARNOLD",
            "state": "MO",
            "postal_code": "630106015",
            "telephone_number": "636-464-5439",
            "fax_number": "636-464-5438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3488 JEFFCO BLVD",
            "address_2": "SUITE 102",
            "city": "ARNOLD",
            "state": "MO",
            "postal_code": "630106015",
            "telephone_number": "636-464-5439",
            "fax_number": "636-464-5438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAUBER",
        "first_name": "KRISTEN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-30",
        "last_updated": "2013-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "MO",
            "license": "2013015514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47065477701",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Arnold, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2013; 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.