Active NPI
Shelby Kae Boatwright, PT, DPT
- Physical Therapist
- Southport, NC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- P23685
- Practice address
- 4002 Executive Park Blvd Ste 800
Southport, NC 28461-9069 - Phone
- (910) 477-6236
- Fax
- (910) 477-6357
- NPI assigned
- Nov 12, 2024
- Sex
- Female
- 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 | P23685 | NC | Primary |
Addresses
Primary practice location
4002 Executive Park Blvd Ste 800
Southport, NC 28461-9069
Mailing address
625 Kenmoor Ave SE Ste 100
Grand Rapids, MI 49546-2395
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4002 Executive Park Blvd
Suite 800
Southport, NC 28461-9069
Phone (910) 477-6326
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P23685 | NC | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peak Performance Sports and Physical Therapy, LLC | Physical Therapist | Current | Accepting new patients |
| Carolina Strong Physical Therapy, LLC | Physical Therapist | Current | Accepting new patients |
Locations
625 Kenmoor Ave SE
Ste 100
Grand Rapids, MI 49546
2009 Neuse Blvd
New Bern, NC 28560
Phone (252) 636-9800
292 Commerce Ave
Southern Pnes, NC 28387
Phone (910) 757-0408
4002 Executive Park Blvd
Ste 800
Southport, NC 28461
Phone (910) 357-5748
4355 NC Highway 211
#D
West End, NC 27376
Phone (910) 310-4850
4355 NC Highway 211
Ste Cd
West End, NC 27376
Phone (910) 466-9123
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- New Bern, NC
- NPI 1194714063
-
- Physical Therapy Clinic/Center
- Southport, NC
- NPI 1851783815
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1731369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731369600000",
"number": "1548084007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "625 KENMOOR AVE SE STE 100",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495462395"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4002 EXECUTIVE PARK BLVD STE 800",
"city": "SOUTHPORT",
"state": "NC",
"postal_code": "284619069",
"telephone_number": "910-477-6236",
"fax_number": "910-477-6357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOATWRIGHT",
"first_name": "SHELBY",
"middle_name": "KAE",
"name_prefix": "Dr.",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-11-12",
"last_updated": "2024-11-12",
"certification_date": "2024-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "P23685",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Southport, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.