NPIMap

Organization Active NPI

Stac Physical Therapy Laguna, Inc

  • Physical Therapist
  • Elk Grove, CA
National Provider Identifier
1639713340
Registry record updated Mar 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
STAC PHYSICAL THERAPY LAGUNA, INC
Practice address
9563 Laguna Springs Dr
Elk Grove, CA 95758-8204
Phone
(916) 691-9822
Fax
(916) 691-9448
NPI assigned
Nov 6, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2025

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

Authorized official

Name
Or NativNPI 1588205587
Title
Director/President
Phone
(650) 796-4048

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Geriatric Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251G0304X
Hand Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251H1200X
Pediatric Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251P0200X
Sports Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251S0007X
Orthopedic Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251X0800X

Addresses

Primary practice location

9563 Laguna Springs Dr
Elk Grove, CA 95758-8204

Mailing address

4432 Fir Ave
Seal Beach, CA 90740-2906
Phone (714) 904-2703

Other names 1

  • Laguna Physical Therapy and Hand Rehabilitation Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251216002238 CA Part B Supplier - Clinic/Group Practice 7416384391 Receives reassigned benefits from 5 practitioners
Practice locations: Elk Grove, CA

National Provider Directory

National Provider Directory

Locations

9563 Laguna Springs Dr
Elk Grove, CA 95758
Phone (916) 224-5918

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1572998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743120000000",
    "number": "1639713340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4432 FIR AVE",
            "city": "SEAL BEACH",
            "state": "CA",
            "postal_code": "907402906",
            "telephone_number": "714-904-2703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9563 LAGUNA SPRINGS DR",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957588204",
            "telephone_number": "916-691-9822",
            "fax_number": "916-691-9448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAC PHYSICAL THERAPY LAGUNA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-06",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A",
        "authorized_official_last_name": "NATIV",
        "authorized_official_first_name": "OR",
        "authorized_official_title_or_position": "DIRECTOR/PRESIDENT",
        "authorized_official_telephone_number": "650-796-4048"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Geriatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251H1200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Hand",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laguna Physical Therapy and Hand Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Laguna Physical Therapy and Hand Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elk Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.