Active NPI
Audrey Gore
- Physical Therapist
- Myrtle Beach, SC
National Provider Identifier
1083140255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3032
- Practice address
- 1200 Ragin St
Myrtle Beach, SC 29577-3346 - Phone
- (843) 424-4824
- NPI assigned
- May 10, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3032 | SC | Primary |
Addresses
Primary practice location
1200 Ragin St
Myrtle Beach, SC 29577-3346
Mailing address
1200 Ragin St
Myrtle Beach, SC 29577-3346
Phone (843) 424-4824
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3032 | SC | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494374400000",
"number": "1083140255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 RAGIN ST",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295773346",
"telephone_number": "843-424-4824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 RAGIN ST",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295773346",
"telephone_number": "843-424-4824"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORE",
"first_name": "AUDREY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-05-10",
"last_updated": "2017-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SC",
"license": "3032",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.