Mark Cebul, PT, DPT, CSCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P16358 Issued in NC

Practice address

10810 Mallard Creek Road
Charlotte, NC 28262-6959

Phone

(704) 510-8000

Fax

(704) 510-8006

NPI assigned

Jun 9, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1465430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1356790380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 CORPORATE PARK DR",
            "address_2": "SUITE A",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281176959",
            "telephone_number": "704-360-2796",
            "fax_number": "704-360-2798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10810 MALLARD CREEK ROAD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282626959",
            "telephone_number": "704-510-8000",
            "fax_number": "704-510-8006"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "136 Corporate Park Dr",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "281176959",
            "country_code": "US",
            "telephone_number": "704-360-2796",
            "fax_number": "704-360-2798",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CEBUL",
        "first_name": "MARK",
        "credential": "PT, DPT, CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-09",
        "last_updated": "2020-10-26",
        "certification_date": "2020-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NC",
            "license": "16358",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P16358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mcebul528854@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "136 Corporate Park Dr",
            "address_2": "Suite A",
            "city": "Mooresville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281176959",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physical Therapist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.