Individual provider Active NPI

Antonia Shoemaker

  • Physical Therapist
  • Mooresville, NC
National Provider Identifier
1033952130
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
P23456 Issued in NC
Practice address
201 N Church St Ste 110
Mooresville, NC 28115-2602
Phone
(704) 909-7808
NPI assigned
Jun 17, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X
Physical Therapist 225100000X P23456 NC Primary

Addresses

Primary practice location

201 N Church St Ste 110
Mooresville, NC 28115-2602

Mailing address

PO Box 412313
Boston, MA 02241-1100
Phone (914) 294-4050

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240828000774 NC Practitioner - Physical Therapist in Private Practice 6800335449 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab North Carolina LLCGroup PAC ID 8820336324, 158 clinicians

Practice addresses (Care Compare)

201 N Church St
Suite 110
Mooresville, NC 28115-2602
Phone (704) 909-7808

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P23456NCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab North Carolina LLC CurrentSince Aug 12, 2024 Accepting new patients
Ivyrehab North Carolina LLC Physical Therapist CurrentSince Aug 12, 2024 Accepting new patients

Locations

9216 Ardrey Kell Rd
Ste 300
Charlotte, NC 28277
Phone (980) 556-7330

5960 Fairview Rd
Ste 250
Charlotte, NC 28210
Phone (980) 224-7958

201 N Church St
Ste 110
Mooresville, NC 28115
Phone (704) 909-7808

1845 E Broad St
Statesville, NC 28625
Phone (980) 890-3255

Organizations & group practices 2

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": "1718582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1033952130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 412313",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022411100",
            "telephone_number": "914-294-4050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N CHURCH ST STE 110",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281152602",
            "telephone_number": "704-909-7808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOEMAKER",
        "first_name": "ANTONIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-17",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P23456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; 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.