Organization Active NPI

Yadkin Physical Therapy, L.L.C.

  • Physical Therapist
  • Yadkinville, NC
National Provider Identifier
1487691390
Registry record updated Jan 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
YADKIN PHYSICAL THERAPY, L.L.C.
Practice address
102 Woodlyn Dr
Yadkinville, NC 27055-6673
Phone
(336) 677-1800
Fax
(336) 677-1802
NPI assigned
May 31, 2006
Last updated
Jan 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2022

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

Authorized official

Name
Kaleb A HillNPI 1700343712
Title
Owner/PT
Phone
(336) 677-1800

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 NU Primary

Addresses

Primary practice location

102 Woodlyn Dr
Yadkinville, NC 27055-6673

Mailing address

102 Woodlyn Dr
Yadkinville, NC 27055-6673
Phone (336) 677-1800

Other identifiers 1

IdentifierTypeStateIssuer
7200452MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060804000284 NC Part B Supplier - Clinic/Group Practice 1557364858 Receives reassigned benefits from 5 practitioners
Practice locations: Yadkinville, NC

National Provider Directory

National Provider Directory

Locations

102 Woodlyn Dr
Yadkinville, NC 27055
Phone (336) 677-1800

105 Woodlyn Dr
Yadkinville, NC 27055
Phone (336) 677-1800

6540 Service Rd
Yadkinville, NC 27055
Phone (336) 677-1800

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642723200000",
    "number": "1487691390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 WOODLYN DR",
            "city": "YADKINVILLE",
            "state": "NC",
            "postal_code": "270556673",
            "telephone_number": "336-677-1800",
            "fax_number": "336-677-1802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 WOODLYN DR",
            "city": "YADKINVILLE",
            "state": "NC",
            "postal_code": "270556673",
            "telephone_number": "336-677-1800",
            "fax_number": "336-677-1802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YADKIN PHYSICAL THERAPY, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A",
        "authorized_official_last_name": "HILL",
        "authorized_official_first_name": "KALEB",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/PT",
        "authorized_official_telephone_number": "336-677-1800"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7200452",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yadkinville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2022; 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.