Active NPI
Stacey Kimball Gorter, DPT
- Physical Therapist
- Fargo, ND
National Provider Identifier
1659843167
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT025859
- Practice address
- 2101 Elm St N
Fargo, ND 58102-2417 - Phone
- (701) 239-3700
- NPI assigned
- Dec 21, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT025859 | PA | Primary |
Addresses
Primary practice location
2101 Elm St N
Fargo, ND 58102-2417
Mailing address
933 Fernon St
Philadelphia, PA 19148-1105
Phone (717) 303-9437
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT025859 | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706486400000",
"number": "1659843167",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "933 FERNON ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191481105",
"telephone_number": "717-303-9437"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 ELM ST N",
"city": "FARGO",
"state": "ND",
"postal_code": "581022417",
"telephone_number": "701-239-3700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORTER",
"first_name": "STACEY",
"middle_name": "KIMBALL",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-21",
"last_updated": "2024-01-29",
"certification_date": "2024-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT025859",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.