Individual provider Active NPI

Stacy Frome Christian, DPT

  • Geriatric Physical Therapist
  • Hurricane, WV
National Provider Identifier
1982736021
Registry record updated Jul 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Physical TherapistTaxonomy code 2251G0304X
License
1991 Issued in WV
Practice address
4000 Out Look Dr
Hurricane, WV 25526-9467
Phone
(304) 757-4102
NPI assigned
Mar 12, 2007
Last updated
Jul 25, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Physical Therapist 2251G0304X 1991 WV Primary

Addresses

Primary practice location

4000 Out Look Dr
Hurricane, WV 25526-9467

Mailing address

4000 Out Look Dr
Hurricane, WV 25526-9467

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151112003134 WV Practitioner - Physical Therapist in Private Practice 0547570038 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
DPT IncGroup PAC ID 4385952100, 6 clinicians

Practice addresses (Care Compare)

5510 Maccorkle Ave SE
Charleston, WV 25304-2320
Phone (304) 720-5433

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1991WVMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
DPT, Inc Geriatrics CurrentSince Nov 22, 2019 Accepting new patients
Charleston Surgical Hospital Healthcare Group, PLLC Past Accepting new patients
Dynamic Physical Therapy and Hand Center, LLC PastSince Nov 22, 2019 Accepting new patients

Locations

5510 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 720-5433

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311552000000",
    "number": "1982736021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 OUT LOOK DR",
            "city": "HURRICANE",
            "state": "WV",
            "postal_code": "255269467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 OUT LOOK DR",
            "city": "HURRICANE",
            "state": "WV",
            "postal_code": "255269467",
            "telephone_number": "304-757-4102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHRISTIAN",
        "first_name": "STACY",
        "middle_name": "FROME",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-12",
        "last_updated": "2011-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "WV",
            "license": "1991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hurricane, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.