Active NPI
Rita L Defazio, PT
- Specialist
- Winston Salem, NC
National Provider Identifier
1174743058
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- PT35845
- Practice address
- 380H Knollwood St # 133
Winston Salem, NC 27103-1815 - Phone
- (336) 692-6820
- NPI assigned
- Apr 26, 2007
- Last updated
- Mar 11, 2011
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 11341 | NC | |
| Specialist | 174400000X | PT35845 | CA | Primary |
| Specialist | 174400000X | NU |
Addresses
Primary practice location
380H Knollwood St # 133
Winston Salem, NC 27103-1815
Mailing address
380H Knollwood St #133
Winstonsalem, NC 27103
Phone (336) 692-6820
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174743058 | Medicaid | TX | |
| 1174743058 | Medicaid | CA | |
| 1174743058 | Medicaid | NC |
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 |
|---|---|---|---|
| PT35845 | CA | MD | Specialist |
| 11341 | NC | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299801600000",
"number": "1174743058",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "380H KNOLLWOOD ST #133",
"city": "WINSTONSALEM",
"state": "NC",
"postal_code": "27103",
"telephone_number": "336-692-6820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "380H KNOLLWOOD ST # 133",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271031815",
"telephone_number": "336-692-6820"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEFAZIO",
"first_name": "RITA",
"middle_name": "L",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-26",
"last_updated": "2011-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NC",
"license": "11341",
"primary": false
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "PT35845",
"primary": true
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1174743058",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1174743058",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1174743058",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
- Dedicated Health
- Dedicated Physicians Group of North Carolina PLLC (Dedicated Senior Medical Center Southside Winston Salem TC)
- Dedicated Physicians Group of North Carolina, PLLC (Dedicated Senior Medical Center Southside Winston Salem)
- Leigh-Ervin Stewart Dedmon, MA, CCC-SLP
- Azra Nicolle Dees, MD
- David Defeo, M.D.
- Defined Home Care LLC
- Gavin R Defisser, MD
- Anthony John Defranzo Jr., MD
- Hayley Degnan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.