Individual provider Active NPI

Sydney Ray, DPT

  • Physical Therapist
  • Raleigh, NC
National Provider Identifier
1639827793
Registry record updated Mar 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
P21066 Issued in NC
Practice address
1300 Corporation Pkwy Ste B
Raleigh, NC 27610-1362
Phone
(919) 917-7729
Fax
(919) 400-4178
NPI assigned
Mar 16, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2022

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 P21066 NC Primary

Addresses

Primary practice location

1300 Corporation Pkwy Ste B
Raleigh, NC 27610-1362

Mailing address

1300 Corporation Pkwy Ste B
Raleigh, NC 27610-1362
Phone (919) 917-7729

Other identifiers 1

IdentifierTypeStateIssuer
P21066OtherNCNORTH CAROLINA PHYSICAL THERAPY ASSOCIATION

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

LicenseStateTypeSpecialty
P21066NCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Revive Boost Rebuild Physical Therapy LLC Physical Therapist CurrentSince Feb 7, 2025 Accepting new patients

Locations

1300 Corporation Pkwy
Ste B
Raleigh, NC 27610
Phone (919) 917-7729

Organizations & group practices 1

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": "1647388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647388800000",
    "number": "1639827793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 CORPORATION PKWY STE B",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101362",
            "telephone_number": "919-917-7729",
            "fax_number": "919-400-4178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 CORPORATION PKWY STE B",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101362",
            "telephone_number": "919-917-7729",
            "fax_number": "919-400-4178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAY",
        "first_name": "SYDNEY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-16",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P21066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH CAROLINA PHYSICAL THERAPY ASSOCIATION",
            "identifier": "P21066",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; 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.