Active NPI
Jamie Sue Stormont-Smith, PT
- Physical Therapist
- Lafayette, IN
National Provider Identifier
1740478015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05002643A
- Practice address
- 80 Professional CT
Lafayette, IN 47905-5152 - Phone
- (765) 448-1758
- Fax
- (765) 448-3898
- NPI assigned
- Oct 11, 2007
- 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 | 05002643A | IN | Primary |
Addresses
Primary practice location
80 Professional CT
Lafayette, IN 47905-5152
Mailing address
80 Professional CT
Lafayette, IN 47905-5152
Phone (765) 448-1758
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200178740 | Medicaid | IN |
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 |
|---|---|---|---|
| 05002643A | IN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1290384000000",
"number": "1740478015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "80 PROFESSIONAL CT",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479055152",
"telephone_number": "765-448-1758",
"fax_number": "765-448-3898"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "80 PROFESSIONAL CT",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479055152",
"telephone_number": "765-448-1758",
"fax_number": "765-448-3898"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STORMONT-SMITH",
"first_name": "JAMIE",
"middle_name": "SUE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-11",
"last_updated": "2010-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05002643A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200178740",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.