Mary Ezzeddine, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P14353 Issued in NC

Practice address

4251 Legion Rd Ste 107
Hope Mills, NC 28348-6200

Phone

(910) 429-0600

Fax

(910) 429-0602

NPI assigned

Aug 1, 2013

Last updated

Aug 24, 2015By 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 2

Addresses

Other names 1

• Mary Broz Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Professional Sportscare & Rehab, LLC

  dba Pivot Physical Therapy

  • Physical Therapist
  • Centreville, VA
  • NPI 1518492511
  NPD (past)

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

{
    "created_epoch": "1375315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440374400000",
    "number": "1194157115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7310 RITCHIE HWY",
            "address_2": "STE 500",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "21061",
            "telephone_number": "410-766-4047",
            "fax_number": "410-766-4049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4251 LEGION RD STE 107",
            "city": "HOPE MILLS",
            "state": "NC",
            "postal_code": "283486200",
            "telephone_number": "910-429-0600",
            "fax_number": "910-429-0602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZZEDDINE",
        "first_name": "MARY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-01",
        "last_updated": "2015-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P14353",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305209477",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "BROZ",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gabrielle Ellis
• Enable LLC
• Chennetha Ephriam
• Sherron R Evans
• Everlasting Care
• Family Habilitative Services
• FHPG, LLC (FirstHealth Family Medicine - Elitecare)
• Deborah Figueroa, MD
• Frank Rueble Fleming, PA
• Rodney Carlton Floyd, PHARMD

• Physical Therapist in Hope Mills, NC
• Providers in Hope Mills, 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 Aug 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.