Stacia R Anderson, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4512 Issued in MN

Practice address

146 Lake St N
Forest Lake, MN 55025-2518

Phone

(651) 464-8502

Fax

(651) 464-8547

NPI assigned

Aug 25, 2006

Last updated

Aug 23, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566518400000",
    "number": "1730297300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7581 9TH ST N STE 100",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551286635",
            "telephone_number": "651-748-4338",
            "fax_number": "651-748-2892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 LAKE ST N",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550252518",
            "telephone_number": "651-464-8502",
            "fax_number": "651-464-8547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "STACIA",
        "middle_name": "R",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2019-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "4512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "436322100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "195K5AN",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP35860",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "6400629",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lori J. Anafarta, LMFT
• Amy Anderson, PHARMD
• Cassie Anderson, MA LPC
• David Michael Anderson, LMFT
• Kathryn A Anderson, SLP
• Taryn Anderson, L.AC.
• Benjamin Luke Andre, DPT
• Laura Lee Arcand, PA-C
• Wendy Kay Arend, MS, DOCTORAL CANDIDA
• Brian J Arnold, PHARM.D.

• Physical Therapist in Forest Lake, MN
• Providers in Forest Lake, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2019; 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.