Individual provider Active NPI

Breanne Parks, PT, DPT

  • Physical Therapist
  • Charlotte, NC
National Provider Identifier
1114224409
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
P15014 Issued in NC
Practice address
2630 E 7TH St Ste 206
Charlotte, NC 28204-4319
Phone
(704) 333-1052
Fax
(704) 333-1054
NPI assigned
Feb 22, 2011
Last updated
Jun 26, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X P15014 NC Primary

Addresses

Primary practice location

2630 E 7TH St Ste 206
Charlotte, NC 28204-4319

Mailing address

2630 E 7TH St Ste 206
Charlotte, NC 28204-4319
Phone (704) 333-1052

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address elitept1@eliteptone.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220817000072 NC Practitioner - Physical Therapist in Private Practice 3072996594 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Elite Physical Therapy LLCGroup PAC ID 0840388666, 4 clinicians

Practice addresses (Care Compare)

8832 Blakeney Professional Dr
Unit 303
Charlotte, NC 28277-6809
Phone (980) 237-4575

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P15014NCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Elite Physical Therapy LLC Physical Therapist CurrentSince Jul 5, 2022 Accepting new patients

Locations

2630 E 7th St
Ste 206
Charlotte, NC 28204
Phone (704) 333-1052

8832 Blakeney Professional Dr
Ste 303
Charlotte, NC 28277
Phone (980) 237-4575

8832 Blakeney Professional Dr
Unit 303
Charlotte, NC 28277
Phone (980) 237-4575

Interoperability endpoints

  • Direct secure messaging: elitept1@eliteptone.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1298332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1114224409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2630 E 7TH ST STE 206",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282044319",
            "telephone_number": "704-333-1052",
            "fax_number": "704-333-1054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 E 7TH ST STE 206",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282044319",
            "telephone_number": "704-333-1052",
            "fax_number": "704-333-1054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKS",
        "first_name": "BREANNE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-22",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P15014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "elitept1@eliteptone.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "2630 E 7th St Ste 206",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282044319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.