Philip Joseph Bissoondial, OTR/ L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

4874 Issued in NC

Practice address

2300 Gallberry LN
Waxhaw, NC 28173-0161

Phone

(704) 649-4509

Fax

(704) 843-9045

NPI assigned

Mar 27, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Milestone Therapy Inc

  • Occupational Therapist
  • Waxhaw, NC
  • NPI 1487824405
  NPD Authorized official

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696464000000",
    "number": "1578682225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 GALLBERRY LN",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281730161",
            "telephone_number": "704-649-4509",
            "fax_number": "704-843-9045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 GALLBERRY LN",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281730161",
            "telephone_number": "704-649-4509",
            "fax_number": "704-843-9045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BISSOONDIAL",
        "first_name": "PHILIP",
        "middle_name": "JOSEPH",
        "credential": "OTR/ L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NC",
            "license": "4874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7301563",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brooke Berridge, OTR/L
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• Terri Jo Biggerstaff Bury, RD, LDN, CDE
• Stephanie Bigham, LCSW
• Valerie Lynn Blatnik, N.P
• Blessing & Beyond
• Katherine Melissa Blevins, LPC-A
• Joseph Charles Blizzard, RPH, PH.D.
• Cassie Lynnae Linker Boland, PHARMD

• Occupational Therapist in Waxhaw, NC
• Providers in Waxhaw, NC by specialty
• Occupational Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.

Verify at the official NPI Registry.