NPIMap

Organization Active NPI

Physical Therapy Center,LLC

Doing business as Ambassador Physical Therapy

  • Physical Therapist
  • Monroe, NC
National Provider Identifier
1053545988
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
9417 Issued in NC
Legal business name
PHYSICAL THERAPY CENTER,LLC
Doing business as
Ambassador Physical Therapy
Practice address
1730 Dickerson Blvd Ste D
Monroe, NC 28110-2884
Phone
(704) 283-6700
Fax
(704) 283-6700
NPI assigned
May 6, 2009
Last updated
Jul 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2025

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

Authorized official

Name
Mr. Todd Douglas Koos, PTNPI 1538278189
Title
Owner/Physical Therapist
Phone
(704) 502-9205

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU
Physical Therapist 225100000X 9417 NC Primary

Addresses

Primary practice location

1730 Dickerson Blvd Ste D
Monroe, NC 28110-2884

Mailing address

1730 Dickerson Blvd Ste D
Monroe, NC 28110-2884
Phone (704) 283-6700

Other practice location 1

2910 Mt Holly Huntersville Rd Ste G
Charlotte, NC 28214-8964
Phone (704) 274-3132

Other practice location 2

1352 Matthews Township Pkwy Ste 102
Matthews, NC 28105-4985
Phone (704) 847-6351

Other practice location 3

105 Waxhaw Professional Park Dr Ste B
Waxhaw, NC 28173-5018
Phone (704) 843-7000

Other identifiers 1

IdentifierTypeStateIssuer
1538278189OtherNCPERSONAL NPI

Other names 1

  • Ambassador Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090805000651 NC Part B Supplier - Clinic/Group Practice 6901959188 Receives reassigned benefits from 8 practitioners
Practice locations: Charlotte, NC; Matthews, NC; Monroe, NC; Waxhaw, NC

National Provider Directory

National Provider Directory

Locations

2910 Mt Holly Huntersville Rd
Ste G
Charlotte, NC 28214
Phone (704) 274-3132

1352 Matthews Township Pkwy
Ste 102
Matthews, NC 28105
Phone (704) 847-6351

105 Waxhaw Professional Park Dr
Ste B
Waxhaw, NC 28173
Phone (704) 459-4013

3901 S Providence Rd
Ste E
Waxhaw, NC 28173
Phone (704) 843-7000

8145 Kensington Dr
Ste C
Waxhaw, NC 28173
Phone (704) 843-7000

2000 Highway 160 W
Ste 113
Fort Mill, SC 29708
Phone (803) 802-0266

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1241568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753142400000",
    "number": "1053545988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 DICKERSON BLVD STE D",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281102884",
            "telephone_number": "704-283-6700",
            "fax_number": "704-283-6713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 DICKERSON BLVD STE D",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281102884",
            "telephone_number": "704-283-6700",
            "fax_number": "704-283-6700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2910 Mt Holly Huntersville Rd Ste G",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282148964",
            "country_code": "US",
            "telephone_number": "704-274-3132",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1352 Matthews Township Pkwy Ste 102",
            "address_purpose": "LOCATION",
            "city": "Matthews",
            "state": "NC",
            "postal_code": "281054985",
            "country_code": "US",
            "telephone_number": "704-847-6351",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "105 Waxhaw Professional Park Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Waxhaw",
            "state": "NC",
            "postal_code": "281735018",
            "country_code": "US",
            "telephone_number": "704-843-7000",
            "fax_number": "704-843-7007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHYSICAL THERAPY CENTER,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-06",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A",
        "authorized_official_last_name": "KOOS",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "704-502-9205",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "9417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL NPI",
            "identifier": "1538278189",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ambassador Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; 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.