STEPHANIE S MACK (PT) – Physical Therapist, NPI 1629076567

STEPHANIE S MACK (PT) is a healthcare provider. based in Woodland, California. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials PT. They hold a License No. PT22464 (CA). The NPI Number for STEPHANIE S MACK (PT) is 1629076567

Main info

Female
30 Years Of Experience
Accepts Medicare Assignment
Name
STEPHANIE S MACK (PT)
NPI
1629076567
Phone
(530) 406-5620
Address
475 PIONEER AVE STE 400
Enumeration Date
13 July 2005
Last Update Date
21 July 2022

Doctor Profile

Medical School Name
HOWARD UNIVERSITY COLLEGE OF MEDICINE
Secondary Phone
5304065600
Graduation Year
1996 (30 years ago)
PAC ID
8123048345
Group Practice PAC ID
9830094515
Professional Enrollment ID
I20051202000534
Address ID
CA957764905WO475XXAVEX303
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:20State licenses:1Digital endpointsOther names

9,448 PHYSICAL THERAPIST IN PRIVATE PRACTICE in CA

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Provider Addresses for STEPHANIE S MACK (PT)

  • 400, Pioneer Avenue, Woodland, Yolo County, California, 95776, United States

    WOODLAND, CA 957764905

    Phone: (530) 406-5620

    Type: Location

  • 9100 S Sepulveda Blvd

    STE 116

    Los Angeles, CA 900454814

    Phone: (310) 649-6470

    Fax: (310) 649-6471

    Type: Location

  • Old Placerville Road, Rancho Cordova, Sacramento County, California, 95655, United States

    SACRAMENTO, CA 958272539

    Phone: (800) 470-0071

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2005-12-02

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20051202000534IPhysical Therapist In Private PracticeCATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
97110Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes64399$0
97112Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes17643$0
97140Therapy procedure using manual technique, each 15 minutes14529$0
97162Evaluation for physical therapy, typically 30 minutes5553$0
97163Evaluation for physical therapy, typically 45 minutes1715$0
View full utilization report →

Insurance plans in this area (ZIP 95776)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9830094515View full group profile
NameSpecialtyState
Diagnostic RadiologyCA
Diagnostic RadiologyCA
Internal MedicineCA
-CA
Family PracticeCA
-CA
-CA
Allergy/Immunology, RheumatologyCA
Physician AssistantCA
Physician AssistantCA

Reviews

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Frequently asked questions

What NPI should I save for STEPHANIE S MACK (PT)?
Save NPI 1629076567 if you need a stable reference for STEPHANIE S MACK (PT).
Is STEPHANIE S MACK (PT)'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What kind of provider is STEPHANIE S MACK (PT)?
The page reflects Physical Therapist for STEPHANIE S MACK (PT). Clinical services aligned with this taxonomy classification.
What location shows for STEPHANIE S MACK (PT)?
We surface Woodland, California for STEPHANIE S MACK (PT) based on available NPPES addresses.
What if Woodland, California seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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