Revive Physical Therapy

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P12005 Issued in NC

Legal business name

REVIVE PHYSICAL THERAPY

Practice address

904 S Walker St Ste B
Burgaw, NC 28425-5008

Phone

(910) 789-4770

Fax

(910) 672-7622

NPI assigned

Feb 13, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Horace Vernon Pigford III, PT

Title

President

Phone

(910) 789-4770

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Horace Vernon Pigford III, PT

  • Physical Therapist
  • Wallace, NC
  • NPI 1043449267
  Medicare reassignment Care Compare group NPD
• Horace Vernon Pigford Jr., PT

  • Physical Therapist
  • Wallace, NC
  • NPI 1417927773
  Medicare reassignment Care Compare group NPD
• Kerry Dawn Daraskavich, DPT

  • Physical Therapist
  • Burgaw, NC
  • NPI 1679816193
  NPD

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

{
    "created_epoch": "1329091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530057600000",
    "number": "1598038119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1799",
            "city": "BURGAW",
            "state": "NC",
            "postal_code": "284251799",
            "telephone_number": "910-789-4770",
            "fax_number": "910-672-7622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 S WALKER ST STE B",
            "city": "BURGAW",
            "state": "NC",
            "postal_code": "284255008",
            "telephone_number": "910-789-4770",
            "fax_number": "910-672-7622"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "338 Spartan Rd",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284053920",
            "country_code": "US",
            "telephone_number": "910-789-4770",
            "fax_number": "910-672-7622",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "338 Spartan Rd",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284053920",
            "country_code": "US",
            "telephone_number": "910-789-4770",
            "fax_number": "910-672-7622",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVIVE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-13",
        "last_updated": "2018-06-27",
        "status": "A",
        "authorized_official_last_name": "PIGFORD",
        "authorized_official_first_name": "HORACE",
        "authorized_official_middle_name": "VERNON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-789-4770",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P12005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Burgaw, NC
• Providers in Burgaw, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.