Active NPI
Roberto Antonio Yuson Imson, PT
- Physical Therapist
- Charlotte, NC
National Provider Identifier
1407696701
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- P10797
- Practice address
- 8801 J M Keynes Dr Ste 300
Charlotte, NC 28262-5473 - Phone
- (910) 619-6079
- NPI assigned
- May 27, 2024
- Last updated
- May 27, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 | P10797 | NC | Primary |
Addresses
Primary practice location
8801 J M Keynes Dr Ste 300
Charlotte, NC 28262-5473
Mailing address
1058 Albany Park Dr
Fort Mill, SC 29715-8805
Phone (910) 619-6079
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P10797 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716768000000",
"number": "1407696701",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1058 ALBANY PARK DR",
"city": "FORT MILL",
"state": "SC",
"postal_code": "297158805",
"telephone_number": "910-619-6079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8801 J M KEYNES DR STE 300",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282625473",
"telephone_number": "910-619-6079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMSON",
"first_name": "ROBERTO ANTONIO",
"middle_name": "YUSON",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-05-27",
"last_updated": "2024-05-27",
"certification_date": "2024-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "P10797",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.