Marissa Medina, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

1129 E Marion St
Shelby, NC 28150-4843

Phone

(704) 471-0001

Fax

(704) 471-0004

NPI assigned

Nov 29, 2020

Last updated

Nov 29, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Custom Physical Therapy and FitnessGroup PAC ID 5890192595, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Custom Physical Therapy and Fitness

  • Physical Therapist
  • Cramerton, NC
  • NPI 1063083384
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1606608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606608000000",
    "number": "1134723356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1377 MOTOR PKWY STE 307",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495258",
            "telephone_number": "914-294-4050",
            "fax_number": "631-760-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 E MARION ST",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281504843",
            "telephone_number": "704-471-0001",
            "fax_number": "704-471-0004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "MARISSA",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-29",
        "last_updated": "2020-11-29",
        "certification_date": "2020-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph McNelis, MD
• Charlotte Lynn McQuaid, LPC
• Jacqueline McDaniel McSwain, LMBT MLD-C
• Rahkala McSwain
• Medicine With Mercy and Grace
• Viral P. Mehta, MD
• Renee B. Melton-Smith, MD
• Jose Daniel Mena Pasquel, MD
• Mental Health & Spiritual Wellness Therapeutic Services
• Gina Michelle Merritt, DO

• Physical Therapist in Shelby, NC
• Providers in Shelby, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2020; 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.