Innovative Physical Therapy Services Inc

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

6107 Issued in NC

Legal business name

INNOVATIVE PHYSICAL THERAPY SERVICES INC

Practice address

503 Canvasback Rd
Mooresville, NC 28117

Phone

(704) 799-9791

Fax

(704) 799-2687

NPI assigned

Jul 20, 2005

Last updated

Aug 22, 2020By 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

Shirley J Dzikowski, PTNPI 1184667321

Title

Owner/Director

Phone

(704) 799-9791

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 2

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.

• Shirley J Dzikowski, P.T.

  • Physical Therapist
  • Mooresville, NC
  • NPI 1184667321
  Medicare reassignment NPD Authorized official
• Ruth B Naylor, P.T.

  • Physical Therapist
  • Mooresville, NC
  • NPI 1083657225
  NPD (past)

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336148279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 CANVASBACK RD",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "28117",
            "telephone_number": "704-799-9791",
            "fax_number": "704-799-2687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 CANVASBACK RD",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "28117",
            "telephone_number": "704-799-9791",
            "fax_number": "704-799-2687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PHYSICAL THERAPY SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DZIKOWSKI",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "704-799-9791",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NC",
            "license": "6107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "32633",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7210608",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5194701",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "6443822",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0149J",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Physical Therapist in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Pediatric Physical Therapist in North Carolina

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