Organization Active NPI

My Personal PT LLC

  • Physical Therapist
  • Candler, NC
National Provider Identifier
1255956330
Registry record updated Jun 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MY PERSONAL PT LLC
Practice address
170 Beaverdam Loop Rd
Candler, NC 28715-9238
Phone
(828) 417-0756
Fax
(828) 417-3658
NPI assigned
Jun 15, 2020
Last updated
Jun 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cary Edgar
Title
Authorized Official
Phone
(480) 206-6240

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

170 Beaverdam Loop Rd
Candler, NC 28715-9238

Mailing address

170 Beaverdam Loop Rd
Candler, NC 28715-9238
Phone (828) 417-0756

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200818000437 NC Part B Supplier - Clinic/Group Practice 3779909064 Practice locations: Candler, NC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1592179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592179200000",
    "number": "1255956330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 BEAVERDAM LOOP RD",
            "city": "CANDLER",
            "state": "NC",
            "postal_code": "287159238",
            "telephone_number": "828-417-0756",
            "fax_number": "828-417-3658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 BEAVERDAM LOOP RD",
            "city": "CANDLER",
            "state": "NC",
            "postal_code": "287159238",
            "telephone_number": "828-417-0756",
            "fax_number": "828-417-3658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY PERSONAL PT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-15",
        "last_updated": "2020-06-15",
        "certification_date": "2020-06-15",
        "status": "A",
        "authorized_official_last_name": "EDGAR",
        "authorized_official_first_name": "CARY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "480-206-6240"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Candler, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.