Active NPI
Stacey Kristine Heronema, DPT
- Physical Therapist
- Gunnison, CO
National Provider Identifier
1871110882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 0017056
- Practice address
- 718 N Main St Unit 18
Gunnison, CO 81230-2412 - Phone
- (970) 641-7389
- NPI assigned
- Jun 26, 2020
- 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 Therapist | 225100000X | 0017056 | CO | Primary |
Addresses
Primary practice location
718 N Main St Unit 18
Gunnison, CO 81230-2412
Mailing address
3776 Palisade Dr
Boulder, CO 80301-3705
Phone (303) 548-7151
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 |
|---|---|---|---|
| 0017056 | CO | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heights Physical Therapy LLC | Physical Therapist | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Lake City, CO
- NPI 1033872973
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593129600000",
"number": "1871110882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3776 PALISADE DR",
"city": "BOULDER",
"state": "CO",
"postal_code": "803013705",
"telephone_number": "303-548-7151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "718 N MAIN ST UNIT 18",
"city": "GUNNISON",
"state": "CO",
"postal_code": "812302412",
"telephone_number": "970-641-7389"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERONEMA",
"first_name": "STACEY",
"middle_name": "KRISTINE",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-06-26",
"last_updated": "2020-06-26",
"certification_date": "2020-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CO",
"license": "0017056",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gunnison, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.