Active NPI
Jessica D Smith, DPT
- Physical Therapist
- Monroe, NC
National Provider Identifier
1265718696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT013497
- Practice address
- 2814 Gray Fox Rd
Monroe, NC 28110-8422 - Phone
- (704) 821-0568
- Fax
- (704) 821-0570
- NPI assigned
- Oct 31, 2011
- Sex
- Female
- 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 | PT013497 | OH | Primary |
Addresses
Primary practice location
2814 Gray Fox Rd
Monroe, NC 28110-8422
Mailing address
2814 Gray Fox Rd
Indian Trail, NC 28079
Phone (704) 821-0568
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
| License | State | Type | Specialty |
|---|---|---|---|
| PT013497 | OH | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Boulevard, PLLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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": "1320019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624579200000",
"number": "1265718696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2814 GRAY FOX RD",
"city": "INDIAN TRAIL",
"state": "NC",
"postal_code": "28079",
"telephone_number": "704-821-0568"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2814 GRAY FOX RD",
"city": "MONROE",
"state": "NC",
"postal_code": "281108422",
"telephone_number": "704-821-0568",
"fax_number": "704-821-0570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "JESSICA",
"middle_name": "D",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-31",
"last_updated": "2021-06-25",
"certification_date": "2020-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OH",
"license": "PT013497",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.