Active NPI
Timothy Dustin Quattlebaum, PT
- Physical Therapist
- Shelby, NC
National Provider Identifier
1225416332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- P15588
- Practice address
- 1129 E Marion St
Shelby, NC 28150-4843 - Phone
- (704) 471-0001
- Fax
- (704) 471-9990
- NPI assigned
- May 8, 2015
- Last updated
- Jan 16, 2020
- 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 | P15588 | NC | Primary |
Addresses
Primary practice location
1129 E Marion St
Shelby, NC 28150-4843
Mailing address
60 Shuford Rd
Columbus, NC 28722-7406
Phone (828) 894-0277
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q53854F938 | Other | NC | MEDICARE PART B |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1431043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579132800000",
"number": "1225416332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 SHUFORD RD",
"city": "COLUMBUS",
"state": "NC",
"postal_code": "287227406",
"telephone_number": "828-894-0277",
"fax_number": "828-894-0278"
},
{
"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": "704-471-9990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUATTLEBAUM",
"first_name": "TIMOTHY",
"middle_name": "DUSTIN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-05-08",
"last_updated": "2020-01-16",
"certification_date": "2020-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "P15588",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PART B",
"identifier": "Q53854F938",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shelby, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 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.