Elder Athlete Physical Therapy PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

ELDER ATHLETE PHYSICAL THERAPY PLLC

Practice address

490 1St Ave S Ste 220
St Petersburg, FL 33701-4287

Phone

(727) 380-4887

Fax

(727) 290-4328

NPI assigned

Feb 10, 2022

Organization subpart

No

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

Authorized official

Name

Lucie Marie Stagg, DPT

Title

Owner

Phone

(727) 380-4887

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1644451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1841944519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 4TH AVE S APT 106",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014621",
            "telephone_number": "727-380-4887",
            "fax_number": "727-290-4328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 1ST AVE S STE 220",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014287",
            "telephone_number": "727-380-4887",
            "fax_number": "727-290-4328"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 4th Ave S Apt 106",
            "address_purpose": "LOCATION",
            "city": "St Petersburg",
            "state": "FL",
            "postal_code": "337014621",
            "country_code": "US",
            "telephone_number": "727-380-4887",
            "fax_number": "727-290-4328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ELDER ATHLETE PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-10",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "STAGG",
        "authorized_official_first_name": "LUCIE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "727-380-4887",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abriana M Ekdahl
• Alauddin El-Hag, MD
• Elara Behavioral Health Services LLC
• Laurie Elbow, LMHC
• Fletcher Eldemire, DO
• Charles David Eldridge IV, MD
• Michael Raymond Eldridge, DVM
• Tiffany Teresa Eldridge, CRNA
• Elena Neveux OD PA
• Elephant Healthcare LLC

• Physical Therapist in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 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.

Verify at the official NPI Registry.