Active NPI
Staci Studer
- Physical Therapist
- Virginia Beach, VA
National Provider Identifier
1992828487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2305202704
- Practice address
- 4560 South Blvd
Suite 310
Virginia Beach, VA 23452-1160 - Phone
- (757) 490-3223
- NPI assigned
- Apr 9, 2007
- Sex
- Female
- Sole proprietor
- No
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 | 2305202704 | VA | Primary |
Addresses
Primary practice location
4560 South Blvd
Suite 310
Virginia Beach, VA 23452-1160
Mailing address
3205 Jade CT
#302
Virginia Beach, VA 23451-1171
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in HI
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
75 -5699 Kopiko St
Kailua Kona, HI 96740-3651
Phone (808) 329-7744
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2305202704 | VA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Club Rehab, Inc. | Physical Therapist | Current | Accepting new patients |
Locations
75-5699 Kopiko St
Kailua Kona, HI 96740
Phone (808) 329-7744
73-5590 Kauhola St
Ste A
Kailua Kona, HI 96740
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992828487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3205 JADE CT",
"address_2": "#302",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234511171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4560 SOUTH BLVD",
"address_2": "SUITE 310",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234521160",
"telephone_number": "757-490-3223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STUDER",
"first_name": "STACI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VA",
"license": "2305202704",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.