NPIMap

Organization Active NPI

Orthopedic Physical Therapy Associates, LLC

  • Physical Therapist
  • Wake Forest, NC
National Provider Identifier
1043465883
Registry record updated Mar 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11432 Issued in NC
Legal business name
ORTHOPEDIC PHYSICAL THERAPY ASSOCIATES, LLC
Practice address
10560 Ligon Mill Rd
Suite 109
Wake Forest, NC 27587-6090
Phone
(919) 556-4678
Fax
(919) 556-4619
NPI assigned
Nov 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2020

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

Authorized official

Name
Olivier Chassin, DPTNPI 1366627382
Title
Owner
Phone
(919) 556-4678

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 11432 NC Primary

Addresses

Primary practice location

10560 Ligon Mill Rd
Suite 109
Wake Forest, NC 27587-6090

Mailing address

10560 Ligon Mill Rd
Suite 109
Wake Forest, NC 27587-6090
Phone (919) 556-4678

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090407000615 NC Part B Supplier - Clinic/Group Practice 7315094463 Receives reassigned benefits from 12 practitioners
Practice locations: Rolesville, NC; Wake Forest, NC

National Provider Directory

National Provider Directory

Locations

1021 Darrington Dr
Ste 205
Cary, NC 27513
Phone (919) 468-0955

101 Redford Place Dr
Ste 102
Rolesville, NC 27571
Phone (919) 229-8097

10560 Ligon Mill Rd
#109
Wake Forest, NC 27587
Phone (919) 556-4619

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1227139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585612800000",
    "number": "1043465883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10560 LIGON MILL RD",
            "address_2": "SUITE 109",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275876090",
            "telephone_number": "919-556-4678",
            "fax_number": "919-556-4619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10560 LIGON MILL RD",
            "address_2": "SUITE 109",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275876090",
            "telephone_number": "919-556-4678",
            "fax_number": "919-556-4619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC PHYSICAL THERAPY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-20",
        "last_updated": "2020-03-31",
        "certification_date": "2020-03-31",
        "status": "A",
        "authorized_official_last_name": "CHASSIN",
        "authorized_official_first_name": "OLIVIER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-556-4678",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "11432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wake Forest, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.