Individual provider Active NPI

Brandon Langworthy, DPT

  • Physical Therapist
  • Fuquay Varina, NC
National Provider Identifier
1578053088
Registry record updated Sep 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
P17907 Issued in NC
Practice address
100 Fitness Dr
Fuquay Varina, NC 27526
Phone
(919) 557-3100
NPI assigned
May 10, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X P17907 NC Primary

Addresses

Primary practice location

100 Fitness Dr
Fuquay Varina, NC 27526

Mailing address

80 Harvey Farm Dr
Benson, NC 27504-6099

Other practice location 1

80 Harvey Farm Dr
Benson, NC 27504-6099
Phone (919) 369-8835

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180821000007 NC Practitioner - Physical Therapist in Private Practice 5698024917 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab North Carolina LLCGroup PAC ID 8820336324, 158 clinicians

Practice addresses (Care Compare)

2100 N Davidson St
Suite C
Charlotte, NC 28205-1828
Phone (980) 556-7780

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P17907NCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab North Carolina LLC Physical Therapist CurrentSince Jan 24, 2022 Accepting new patients
Ivyrehab North Carolina LLC CurrentSince Jan 24, 2022 Accepting new patients

Locations

9216 Ardrey Kell Rd
Ste 300
Charlotte, NC 28277
Phone (980) 556-7330

2100 N Davidson St
Ste C
Charlotte, NC 28205
Phone (980) 556-7780

5960 Fairview Rd
Ste 250
Charlotte, NC 28210
Phone (980) 224-7958

100 Fitness Dr
Fuquay Varina, NC 27526
Phone (919) 557-3100

500 Village Walk Dr
Holly Springs, NC 27540
Phone (919) 258-2200

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.

NPI Registry JSON

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

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1578053088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 HARVEY FARM DR",
            "city": "BENSON",
            "state": "NC",
            "postal_code": "275046099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 FITNESS DR",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "27526",
            "telephone_number": "919-557-3100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "80 Harvey Farm Dr",
            "address_purpose": "LOCATION",
            "city": "Benson",
            "state": "NC",
            "postal_code": "275046099",
            "country_code": "US",
            "telephone_number": "919-369-8835",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANGWORTHY",
        "first_name": "BRANDON",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-10",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P17907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fuquay Varina, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; 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.

Verify at the official NPI Registry.