Individual provider Active NPI

Michael Fitzgerald

  • Physical Therapist
  • Wilmington, NC
National Provider Identifier
1154430213
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
2001 S 17TH St
Ste 101
Wilmington, NC 28401-6628
Phone
(970) 763-8184
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 Primary

Addresses

Primary practice location

2001 S 17TH St
Ste 101
Wilmington, NC 28401-6628

Mailing address

4614 Whiteweld Ter
Wilmington, NC 28412-5205
Phone (910) 313-0730

Other identifiers 1

IdentifierTypeStateIssuer
8519OtherNCLICENSE #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070609000013 NC Practitioner - Physical Therapist in Private Practice 4082712328 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8519NCMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Proactive Therapy of North Carolina Inc CurrentSince Oct 1, 2024 Accepting new patients
Proactive Therapy of North Carolina Inc CurrentSince Oct 1, 2024 Accepting new patients
Proactive Therapy of North Carolina Inc Current Accepting new patients
Select Physical Therapy Holdings Inc CurrentSince Oct 1, 2024 Accepting new patients
Select Physical Therapy Holdings Inc CurrentSince Oct 1, 2024 Accepting new patients

Locations

10020 Edison Square Dr NW
Ste C105
Concord, NC 28027
Phone (704) 948-5351

2358 US Highway 70
Ste Ab
Swannanoa, NC 28778
Phone (828) 686-3375

1259 Highland Dr
Washington, NC 27889
Phone (252) 243-0072

2001 S 17th St
#101
Wilmington, NC 28401
Phone (910) 763-8184

4815 Oleander Dr
Ste 200
Wilmington, NC 28403
Phone (910) 313-3077

4815 Oleander Dr
Wilmington, NC 28403
Phone (910) 313-3077

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154430213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4614 WHITEWELD TER",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284125205",
            "telephone_number": "910-313-0730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S 17TH ST",
            "address_2": "STE 101",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016628",
            "telephone_number": "970-763-8184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "8519",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.