Individual provider Active NPI

Scott W Eiselt, PT

  • Physical Therapist
  • Charlotte, NC
National Provider Identifier
1255424560
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
10709 Issued in NC
Practice address
1100 Blythe Blvd
Charlotte, NC 28203-5814
Phone
(704) 355-8484
Fax
(704) 355-4231
NPI assigned
Oct 2, 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 10709 NC Primary

Addresses

Primary practice location

1100 Blythe Blvd
Charlotte, NC 28203-5814

Mailing address

1100 Blythe Blvd
Charlotte, NC 28203-5814
Phone (704) 355-8484

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

State licenses

LicenseStateTypeSpecialty
10709NCMDPhysical Therapist
6669SCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Imc of South Carolina Physical Therapist CurrentSince Aug 22, 2012 Accepting new patients
Imc of South Carolina Physical Therapist CurrentSince Aug 22, 2012 Accepting new patients
Imc of South Carolina Physical Therapist Current Accepting new patients
Brett Russell Physical Therapy and Fitness LLC Physical Therapist PastSince Aug 22, 2012 Accepting new patients
Premise Health of South Carolina Medical PC PastSince Aug 22, 2012 Accepting new patients

Locations

2615 Centennial Blvd
Ste 101
Tallahassee, FL 32308

1 Bib Way
Anderson, SC 29626
Phone (864) 458-1894

10 Parkway S
Greenville, SC 29615
Phone (864) 458-6933

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": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255424560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035814",
            "telephone_number": "704-355-8484",
            "fax_number": "704-355-4231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035814",
            "telephone_number": "704-355-8484",
            "fax_number": "704-355-4231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EISELT",
        "first_name": "SCOTT",
        "middle_name": "W",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "10709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.