Custom Physical Therapy and Fitness
Organization Active NPI Physical Therapist · Cramerton, NC
NPI 1063083384 · NPPES record last updated Sep 4, 2024
Key facts
- NPI
- 1063083384
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- CUSTOM PHYSICAL THERAPY AND FITNESS
- Practice address
- 102 Hidden Pastures Dr Ste 106
Cramerton, NC 28032-1697 - Phone
- (563) 505-4524
- NPI assigned
- Jul 7, 2021
- Organization subpart
- No
Authorized official
- Name
- Kathryn E Miller, DPT, OCS
- Title
- Owner
- Phone
- (563) 505-4524
Practitioners 8
-
Alex J Brooket, DPT
-
Marissa Medina, PT, DPT
-
Kathryn E Miller, P.T.
-
Nathan Tometich, DPT
-
Emily Grace Worley, PT, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210923000051 | NC | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 5890192595 |
Receives reassigned benefits from 8 practitioners Practice locations: Belmont, NC; McAdenville, NC |
National Provider Directory
Locations
100 Main St
Mc Adenville, NC 28101
102 Main St
Ste 130
Mc Adenville, NC 28101
Phone (704) 560-6135
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes |
Addresses
Primary practice location
102 Hidden Pastures Dr Ste 106
Cramerton, NC 28032-1697
Mailing address
102 Hidden Pastures Dr Ste 106
Cramerton, NC 28032-1697
Other providers in Cramerton, NC
- A Time for Everything, LLC
- Carillon Assisted Living of Cramer Mountain
- Jeff Darracott
- Kristy Suzanne Deal
- Dunaways Inc
- Ec Opco Cramerton LP
- Gaston Family Health Services Inc
All providers in Cramerton, NC · Physical Therapist in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.