Active NPI
Regina Sherice Brunson, PT
- Physical Therapist
- Indian Trail, NC
National Provider Identifier
1124210075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10527
- Practice address
- 598 Indian Trail Rd S Ste 141
Indian Trail, NC 28079-8689 - Phone
- (704) 975-7008
- Fax
- (704) 821-0570
- NPI assigned
- Aug 14, 2007
- Sex
- Female
- Sole proprietor
- No
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 | 10527 | NC | Primary |
Addresses
Primary practice location
598 Indian Trail Rd S Ste 141
Indian Trail, NC 28079-8689
Mailing address
4312 Sugarstone LN Apt 224
Charlotte, NC 28269-3247
Phone (704) 597-1262
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 |
|---|---|---|---|
| 10527 | NC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187049600000",
"number": "1124210075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4312 SUGARSTONE LN APT 224",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282693247",
"telephone_number": "704-597-1262",
"fax_number": "704-821-0570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "598 INDIAN TRAIL RD S STE 141",
"city": "INDIAN TRAIL",
"state": "NC",
"postal_code": "280798689",
"telephone_number": "704-975-7008",
"fax_number": "704-821-0570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNSON",
"first_name": "REGINA",
"middle_name": "SHERICE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-14",
"last_updated": "2007-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "10527",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indian Trail, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.