NPIMap

Individual provider Active NPI

Stephanie Lynn Foraker, DPT

  • Physical Therapist
  • Fruit Cove, FL
National Provider Identifier
1598062853
Registry record updated Sep 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT28730 Issued in FL
Practice address
445 State Road 13 N Ste 21
Fruit Cove, FL 32259-2824
Phone
(904) 239-5715
NPI assigned
Feb 23, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305206815 VA
Physical Therapist 225100000X P20025 NC
Physical Therapist 225100000X PT28730 FL Primary

Addresses

Primary practice location

445 State Road 13 N Ste 21
Fruit Cove, FL 32259-2824

Mailing address

445 State Road 13 N Ste 21
Fruit Cove, FL 32259-2824
Phone (904) 239-5715

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address stephanie.foraker.1@9526.direct.athenahealth.com Direct

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
PT28730FLMDPhysical Therapist
P20025NCMDPhysical Therapist
2305206815VAMDPhysical Therapist

Interoperability endpoints

  • Direct secure messaging: stephanie.foraker.1@9526.direct.athenahealth.com

NPI Registry JSON

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

{
    "created_epoch": "1298419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693526400000",
    "number": "1598062853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 STATE ROAD 13 N STE 21",
            "city": "FRUIT COVE",
            "state": "FL",
            "postal_code": "322592824",
            "telephone_number": "904-239-5715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 STATE ROAD 13 N STE 21",
            "city": "FRUIT COVE",
            "state": "FL",
            "postal_code": "322592824",
            "telephone_number": "904-239-5715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORAKER",
        "first_name": "STEPHANIE",
        "middle_name": "LYNN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-23",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305206815",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P20025",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT28730",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stephanie.foraker.1@9526.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "775-2 W Corbett Avenue",
            "city": "Swansboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "285848563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fruit Cove, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; 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.