Proactive Physical Therapy & Performance LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PROACTIVE PHYSICAL THERAPY & PERFORMANCE LLC

Practice address

3607 Falls River Ave Ste 111
Raleigh, NC 27614-7365

Phone

(919) 378-1923

NPI assigned

Mar 19, 2024

Last updated

Mar 19, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Deandra Cotten, PT, DPTNPI 1871128322

Title

Owner, Physical Therapist

Phone

(910) 922-0126

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Deandra Cotten

  • Physical Therapist
  • Fayetteville, NC
  • NPI 1871128322
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1689434532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1637 HOLLOMAN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283129321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3607 FALLS RIVER AVE STE 111",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276147365",
            "telephone_number": "919-378-1923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE PHYSICAL THERAPY & PERFORMANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "COTTEN",
        "authorized_official_first_name": "DEANDRA",
        "authorized_official_title_or_position": "OWNER, PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "910-922-0126",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shaunda Nicole Privette Fennell, CD(DONA)
• Priya N Tailor DMD PLLC (Midtown Smiles)
• Pro Motion Physical Therapy LLC
• Proactive Health Chiropractic PLLC (Proactive Health Solutions)
• Proactive Performance Centers, LLC
• Proactive Therapy of North Carolina Inc (Select Physical Therapy)
• Megan Jessica Probasco, FNP
• Daniel Prober
• Cheryl Proctor, F.N.P.
• Jacob Lee Proctor, PT

• Physical Therapist in Raleigh, NC
• Providers in Raleigh, 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 Mar 19, 2024; 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.