Active NPI
Susan Goldenberg Stovall, PT
- Physical Therapist
- Southern Pines, NC
National Provider Identifier
1730141409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2089
- Practice address
- 210 S Bennett St
Southern Pines, NC 28387-5402 - Phone
- (910) 692-8269
- Fax
- (910) 692-8479
- NPI assigned
- Apr 6, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2089 | NC | Primary |
Addresses
Primary practice location
210 S Bennett St
Southern Pines, NC 28387-5402
Mailing address
210 S Bennett St
Southern Pines, NC 28387-5402
Phone (910) 692-8269
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0775R | Other | NC | BLUE CROSS BLUE SHIELD |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2089 | NC | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287360000000",
"number": "1730141409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 S BENNETT ST",
"city": "SOUTHERN PINES",
"state": "NC",
"postal_code": "283875402",
"telephone_number": "910-692-8269",
"fax_number": "910-692-8479"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 S BENNETT ST",
"city": "SOUTHERN PINES",
"state": "NC",
"postal_code": "283875402",
"telephone_number": "910-692-8269",
"fax_number": "910-692-8479"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOVALL",
"first_name": "SUSAN",
"middle_name": "GOLDENBERG",
"name_prefix": "Dr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-06",
"last_updated": "2010-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "2089",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0775R",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southern Pines, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.