Mickalia Jessmine Warren-Hunter
Individual provider Active NPI Physical Therapist · Concord, NC
NPI 1679338644 · NPPES record last updated Feb 19, 2024
Key facts
- NPI
- 1679338644
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- P23022 (NC)
- Practice address
- 928 Copperfield Blvd NE
Concord, NC 28025-2433 - Phone
- (704) 885-1447
- NPI assigned
- Feb 19, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ivyrehab North Carolina LLC
Practice addresses (Care Compare)
3627 Beatties Ford Rd
Suite 200
Charlotte, NC 28216-3249
Phone (984) 297-8155
9216 Ardrey Kell Rd
Suite 300
Charlotte, NC 28277-4954
Phone (980) 556-7330
9325 JW Clay Blvd
Suite 224
Charlotte, NC 28262-5411
Phone (704) 755-4278
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240321002194 | NC | Practitioner - Physical Therapist in Private Practice | 6103263553 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P23022 | NC | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ivyrehab North Carolina LLC | Physical Therapist | Current |
Accepting new patients |
| Finnerty Beck LLC | Physical Therapist | Current |
Accepting new patients |
| Ivyrehab North Carolina LLC | Current |
Accepting new patients |
Locations
5960 Fairview Rd
Ste 250
Charlotte, NC 28210
Phone (980) 224-7958
3627 Beatties Ford Rd
Ste 3249
Charlotte, NC 28216
Phone (984) 297-8155
9392 Sullivan Vale Ln
Charlotte, NC 28215
Phone (980) 701-5757
9216 Ardrey Kell Rd
Ste 300
Charlotte, NC 28277
Phone (980) 556-7330
928 Copperfield Blvd NE
Concord, NC 28025
Phone (704) 786-7676
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | P23022 | NC | Yes |
Addresses
Primary practice location
928 Copperfield Blvd NE
Concord, NC 28025-2433
Mailing address
4119 Napa Oak Dr Apt 209
Charlotte, NC 28216-9132
Phone (843) 812-5193
Other providers in Concord, NC
- Edith Joan Ware
- Toussaint Ware
- Jaidyn Warlick
- Warm Hearts Home Health Care
- Jennifer Warner
- Amber Rose Washington-Lapresta
- Blossom Eleithia Washington
- Stephanie Washington
- Tamara V Washington
- Samantha Wasserbauer
All providers in Concord, NC · Physical Therapist in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.