Active NPI
Stacy L Bellows, PTA
- Physical Therapy Assistant
- Osceloa, WI
National Provider Identifier
1992375299
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 3180-19
- Practice address
- 2650 65TH Ave
Osceloa, WI 54020 - Phone
- (715) 294-1100
- NPI assigned
- Jun 29, 2021
- 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 Therapy Assistant | 225200000X | 3180-19 | WI | Primary |
Addresses
Primary practice location
2650 65TH Ave
Osceloa, WI 54020
Mailing address
2650 65TH Ave
Osceola, WI 54020
Phone (715) 294-1100
Other names 1
- Stacy L Miller
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3180-19 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624924800000",
"number": "1992375299",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2650 65TH AVE",
"city": "OSCEOLA",
"state": "WI",
"postal_code": "54020",
"telephone_number": "715-294-1100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2650 65TH AVE",
"city": "OSCELOA",
"state": "WI",
"postal_code": "54020",
"telephone_number": "715-294-1100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BELLOWS",
"first_name": "STACY",
"middle_name": "L",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-06-29",
"last_updated": "2021-06-29",
"certification_date": "2021-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "3180-19",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "STACY",
"last_name": "MILLER",
"middle_name": "L",
"credential": "PTA",
"code": "1",
"type": "Former Name"
}
]
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.