Active NPI
Stacy Warren, DPT
- Pediatric Physical Therapist
- Hurricane, WV
National Provider Identifier
1669879078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- PT 003420
- Practice address
- 179 Station PL
Suite 100
Hurricane, WV 25526-6578 - Phone
- (304) 760-6300
- Fax
- (304) 201-5123
- NPI assigned
- Dec 1, 2014
- 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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | PT 003420 | WV | Primary |
Addresses
Primary practice location
179 Station PL
Suite 100
Hurricane, WV 25526-6578
Mailing address
5474 Shawnee Cir Apt. 30
Huntington, WV 25703-3377
Phone (740) 671-8458
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 |
|---|---|---|---|
| PT 003420 | WV | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1417392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1417392000000",
"number": "1669879078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5474 SHAWNEE CIR APT. 30",
"city": "HUNTINGTON",
"state": "WV",
"postal_code": "257033377",
"telephone_number": "740-671-8458",
"fax_number": "304-201-5123"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "179 STATION PL",
"address_2": "SUITE 100",
"city": "HURRICANE",
"state": "WV",
"postal_code": "255266578",
"telephone_number": "304-760-6300",
"fax_number": "304-201-5123"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WARREN",
"first_name": "STACY",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-12-01",
"last_updated": "2014-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "WV",
"license": "PT 003420",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hurricane, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.