Active NPI
Kenneth Bradley Hancock, MPT
- Physical Therapist
- Raleigh, NC
National Provider Identifier
1528207602
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 9658
- Practice address
- 3708 Forestview Rd
Suite 101
Raleigh, NC 27612-8042 - Phone
- (919) 786-7434
- Fax
- (919) 786-7437
- NPI assigned
- Feb 12, 2009
- Last updated
- Jan 27, 2020
- Sex
- Male
- Sole proprietor
- No
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 | 9658 | NC | Primary |
Addresses
Primary practice location
3708 Forestview Rd
Suite 101
Raleigh, NC 27612-8042
Mailing address
350 New Fidelity CT
Garner, NC 27529-2665
Phone (919) 258-2714
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4757 | SC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carolina Sportscare and Physical Therapy | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Beaufort, SC
- NPI 1659306785
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580083200000",
"number": "1528207602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 NEW FIDELITY CT",
"city": "GARNER",
"state": "NC",
"postal_code": "275292665",
"telephone_number": "919-258-2714",
"fax_number": "919-535-3271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3708 FORESTVIEW RD",
"address_2": "SUITE 101",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276128042",
"telephone_number": "919-786-7434",
"fax_number": "919-786-7437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANCOCK",
"first_name": "KENNETH",
"middle_name": "BRADLEY",
"name_prefix": "Mr.",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-02-12",
"last_updated": "2020-01-27",
"certification_date": "2020-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "9658",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 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.