Active NPI
Stacy M Walters
- Physical Therapy Assistant
- Tampa, FL
National Provider Identifier
1780250332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 24314
- Practice address
- 15002 Hutchison Rd
Tampa, FL 33625-5509 - Phone
- (813) 969-1969
- NPI assigned
- Jun 2, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 Therapy Assistant | 225200000X | 24314 | FL | Primary |
Addresses
Primary practice location
15002 Hutchison Rd
Tampa, FL 33625-5509
Mailing address
13150 Royal Pines Ave
Riverview, FL 33579-9321
Phone (419) 271-3613
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 |
|---|---|---|---|
| 24314 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624579200000",
"number": "1780250332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13150 ROYAL PINES AVE",
"city": "RIVERVIEW",
"state": "FL",
"postal_code": "335799321",
"telephone_number": "419-271-3613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15002 HUTCHISON RD",
"city": "TAMPA",
"state": "FL",
"postal_code": "336255509",
"telephone_number": "813-969-1969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTERS",
"first_name": "STACY",
"middle_name": "M",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-06-02",
"last_updated": "2021-06-25",
"certification_date": "2021-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "24314",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.