NPIMap

Organization Active NPI

Physical Therapy Clinic Inc

Doing business as Axis Physical Therapy

  • Physical Therapist
  • Jacksonville, NC
National Provider Identifier
1285679373
Registry record updated Aug 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4047 Issued in NC
Legal business name
PHYSICAL THERAPY CLINIC INC
Doing business as
Axis Physical Therapy
Practice address
26 Office Park Dr
Jacksonville, NC 28546
Phone
(910) 577-3355
Fax
(910) 577-4556
NPI assigned
Jun 20, 2006
Last updated
Aug 22, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2018

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

Authorized official

Name
Mrs. Leanne Lyon Burns, PTNPI 1659317063
Title
President/Owner/PT
Phone
(910) 577-3355

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 4047 NC Primary

Addresses

Primary practice location

26 Office Park Dr
Jacksonville, NC 28546

Mailing address

26 Office Park Dr
Jacksonville, NC 28546-7325
Phone (910) 577-3355

Other identifiers 3

IdentifierTypeStateIssuer
0229MOtherNCBLUE CROSS & BLUE SHIELD
70592OtherNCMEDCOST
153455500OtherNCFED W/C OWCP

Other names 2

  • Axis Physical Therapy Doing business as
  • The Physical Therapy Clinic, Inc. Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040120000895 NC Part B Supplier - Clinic/Group Practice 7810898970 Receives reassigned benefits from 4 practitioners
Practice locations: Jacksonville, NC

National Provider Directory

National Provider Directory

Locations

26 Office Park Dr
Jacksonville, NC 28546
Phone (910) 550-0367

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534896000000",
    "number": "1285679373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 OFFICE PARK DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285467325",
            "telephone_number": "910-577-3355",
            "fax_number": "910-577-4556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 OFFICE PARK DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "28546",
            "telephone_number": "910-577-3355",
            "fax_number": "910-577-4556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2018-08-22",
        "status": "A",
        "authorized_official_last_name": "BURNS",
        "authorized_official_first_name": "LEANNE",
        "authorized_official_middle_name": "LYON",
        "authorized_official_title_or_position": "PRESIDENT/OWNER/PT",
        "authorized_official_telephone_number": "910-577-3355",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "4047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "0229M",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "70592",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FED W/C OWCP",
            "identifier": "153455500",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Axis Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Physical Therapy Clinic, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jacksonville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2018; 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.