Active NPI
Timothy Pendergrass, PT, DSC, ATC
- Physical Therapist
- Ft Bragg, NC
National Provider Identifier
1215927454
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1099471
- Practice address
- BLDG 0-1900
Lamont Road
Ft Bragg, NC 23807 - Phone
- (910) 643-1471
- NPI assigned
- Oct 27, 2005
- Sex
- Male
- 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 | 1099471 | TX | Primary |
Addresses
Primary practice location
BLDG 0-1900
Lamont Road
Ft Bragg, NC 23807
Mailing address
5448 Edsall Ridge PL
Alexandria, VA 22312-2673
Phone (301) 318-6217
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 |
|---|---|---|---|
| 1099471 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579824000000",
"number": "1215927454",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5448 EDSALL RIDGE PL",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "223122673",
"telephone_number": "301-318-6217"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "BLDG 0-1900",
"address_2": "LAMONT ROAD",
"city": "FT BRAGG",
"state": "NC",
"postal_code": "23807",
"telephone_number": "910-643-1471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDERGRASS",
"first_name": "TIMOTHY",
"credential": "PT, DSC, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-27",
"last_updated": "2020-01-24",
"certification_date": "2020-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1099471",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ft Bragg, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.