Providence Physical Therapy & Performance, LLC.

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

10244 Issued in NC

Legal business name

PROVIDENCE PHYSICAL THERAPY & PERFORMANCE, LLC.

Practice address

107 Live Oak St
Tabor City, NC 28463-2042

Phone

(252) 916-9949

NPI assigned

Jul 20, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Kevin Brian Bullard, DPTNPI 1639111594

Title

Physical Therapist/Owner/Manager

Phone

(252) 916-9949

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Kevin B Bullard, MPT

  • Physical Therapist
  • Tabor City, NC
  • NPI 1639111594
  Authorized official Same address or phone

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

{
    "created_epoch": "1468972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486339200000",
    "number": "1104279520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 219",
            "city": "TABOR CITY",
            "state": "NC",
            "postal_code": "284630219",
            "telephone_number": "910-377-3146",
            "fax_number": "910-377-3277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 LIVE OAK ST",
            "city": "TABOR CITY",
            "state": "NC",
            "postal_code": "284632042",
            "telephone_number": "252-916-9949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PHYSICAL THERAPY & PERFORMANCE, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-20",
        "last_updated": "2017-02-06",
        "status": "A",
        "authorized_official_last_name": "BULLARD",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/OWNER/MANAGER",
        "authorized_official_telephone_number": "252-916-9949",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NC",
            "license": "10244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• McLeod Physician Associates II (McLeod Primary Care Tabor City)
• Medicine Mart LTC, LLC
• MH Medical Services, PC
• Palmetto Healthcare Inc. (Waterbrooke Assisted Living)
• Premier Behavioral Services Inc
• Raintree Healthcare of Tabor City, LLC (Waterbrooke Assisted Living)
• Diane Carol Rambeau, LCSW
• Rha Health Services NC LLC
• Paul A Rhodes, CRNP-C
• Serenity Hill Homes Inc

• Physical Therapy Clinic/Center in Tabor City, NC
• Providers in Tabor City, NC by specialty
• Physical Therapy Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 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.

Verify at the official NPI Registry.