Active NPI
Leann Nicole Domitrovits
- Physical Therapist
- Concord, NC
National Provider Identifier
1548947856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- P21939
- Practice address
- 1090 NE Gateway CT NE Ste 101
Concord, NC 28025-2424 - Phone
- (704) 403-9100
- NPI assigned
- Jun 28, 2023
- 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 | P21939 | NC | Primary |
Addresses
Primary practice location
1090 NE Gateway CT NE Ste 101
Concord, NC 28025-2424
Mailing address
4712 McAlpine LN
Charlotte, NC 28212-8542
Phone (928) 817-7022
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 |
|---|---|---|---|
| P21939 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687910400000",
"number": "1548947856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4712 MCALPINE LN",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282128542",
"telephone_number": "928-817-7022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1090 NE GATEWAY CT NE STE 101",
"city": "CONCORD",
"state": "NC",
"postal_code": "280252424",
"telephone_number": "704-403-9100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMITROVITS",
"first_name": "LEANN",
"middle_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-28",
"last_updated": "2023-06-28",
"certification_date": "2023-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "P21939",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.