Providence Physical Therapy, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

PROVIDENCE PHYSICAL THERAPY, LLC

Practice address

107 Triton LN
Surf City, NC 28445-6923

Phone

(910) 803-2040

Fax

(910) 803-2050

NPI assigned

Aug 22, 2017

Last updated

Apr 14, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Alan DeitzNPI 1508859034

Title

Owner/Manager

Phone

(901) 803-2040

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 4

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.

• David Alan Deitz, PT, DPT, OCS

  • Physical Therapist
  • Surf City, NC
  • NPI 1508859034
  Medicare reassignment Care Compare group Authorized official
• Keely Peterson Brown, PT

  • Physical Therapist
  • Surf City, NC
  • NPI 1366877870
  Medicare reassignment Care Compare group NPD
• Ryan Peter Busalacchi, DPT

  • Physical Therapist
  • Jacksonville, NC
  • NPI 1508548900
  Medicare reassignment Care Compare group NPD
• Tina Fortier, PT

  • Physical Therapist
  • Surf City, NC
  • NPI 1184896946
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1503360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776124800000",
    "number": "1326564287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "271 HICKORY POINT RD",
            "city": "HAMPSTEAD",
            "state": "NC",
            "postal_code": "284432633",
            "telephone_number": "724-288-1629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 TRITON LN",
            "city": "SURF CITY",
            "state": "NC",
            "postal_code": "284456923",
            "telephone_number": "910-803-2040",
            "fax_number": "910-803-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-22",
        "last_updated": "2026-04-14",
        "certification_date": "2026-04-14",
        "status": "A",
        "authorized_official_last_name": "DEITZ",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "901-803-2040"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald Wayne O'Neil Jr., D.C.
• Gail Ostrishko, LPC
• Judith Paliotti, RPH
• Heather R Perkins, LPC, LCMHCA, LCASA
• Primary Vision Care Center, O.D., P.a.
• Sandy Shores Medical Center and Urgent Care
• Sandy Shores Primary Care, PLLC
• Tina Marie Stanley, R.T.
• Still Waters Therapy PLLC
• Danielle D Sullivan, LMFTA

• Physical Therapy Clinic/Center in Surf City, NC
• Providers in Surf City, NC by specialty
• Physical Therapy Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2026; 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.