NPIMap

Individual provider Active NPI

Stefanie Ann Decaria, DPT

  • Physical Therapist
  • Edmonds, WA
National Provider Identifier
1851601306
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT60167149 Issued in WA
Practice address
21009 76TH Ave W
Edmonds, WA 98026-7126
Phone
(425) 672-2910
Fax
(425) 778-1872
NPI assigned
Oct 18, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT60167149 WA Primary

Addresses

Primary practice location

21009 76TH Ave W
Edmonds, WA 98026-7126

Mailing address

21009 76TH Ave W
Edmonds, WA 98026-7126
Phone (425) 672-2910

Other identifiers 1

IdentifierTypeStateIssuer
PT60167149OtherWASTATE LICENSE ID NUMBER

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sdecaria59981@direct.med.utah.edu Direct University of Utah

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

Practice roles

OrganizationSpecialtyStatusNew patients
Martha Lake Physical Therapy Inc Physical Therapist Past Accepting new patients
Axis Physical Therapy Inc Physical Therapist PastSince Aug 13, 2012 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1287360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1851601306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21009 76TH AVE W",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267126",
            "telephone_number": "425-672-2910",
            "fax_number": "425-778-1872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21009 76TH AVE W",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267126",
            "telephone_number": "425-672-2910",
            "fax_number": "425-778-1872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECARIA",
        "first_name": "STEFANIE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-18",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60167149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE ID NUMBER",
            "identifier": "PT60167149",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sdecaria59981@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Edmonds, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.