Active NPI
Star Barry Stevenson, MSPT
- Physical Therapist
- Santa Rosa, CA
National Provider Identifier
1821747932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 25565
- Practice address
- 34 Mark West Springs Rd
Santa Rosa, CA 95403-1766 - Phone
- (707) 546-1922
- NPI assigned
- Mar 23, 2022
- Sex
- Male
- 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 Therapist | 225100000X | 25565 | CA | Primary |
Addresses
Primary practice location
34 Mark West Springs Rd
Santa Rosa, CA 95403-1766
Mailing address
4909 Stonehedge Dr
Santa Rosa, CA 95405-7443
Phone (707) 483-5876
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25565 | CA | MD | Basic Emergency Medical Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647993600000",
"number": "1821747932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4909 STONEHEDGE DR",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954057443",
"telephone_number": "707-483-5876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34 MARK WEST SPRINGS RD",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954031766",
"telephone_number": "707-546-1922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEVENSON",
"first_name": "STAR",
"middle_name": "BARRY",
"name_prefix": "Mr.",
"credential": "MSPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-03-23",
"last_updated": "2022-03-23",
"certification_date": "2022-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "25565",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.