Casey Roark, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P21928 Issued in NC

Practice address

4833 Berewick Town Center Dr Ste H
Charlotte, NC 28278-6721

Phone

(980) 880-6780

NPI assigned

Feb 17, 2023

Last updated

Feb 24, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC, SC2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ivyrehab North Carolina LLC

  • Physical Medicine & Rehabilitation Physician
  • Charlotte, NC
  • NPI 1629568647

  Physical Therapist

  Medicare reassignment NPD
• Ivyrehab Focus, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Lake Wylie, SC
  • NPI 1518105279

  Physical Therapist

  Medicare reassignment NPD
• Ivyrehab North Carolina LLC

  • Physical Medicine & Rehabilitation Physician
  • Charlotte, NC
  • NPI 1528683935
  NPD
• Ivyrehab Focus, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Rock Hill, SC
  • NPI 1902443880
  NPD

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

{
    "created_epoch": "1676592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677196800000",
    "number": "1730887910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4833 BEREWICK TOWN CENTER DR STE H",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282786721",
            "telephone_number": "980-880-6780"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8811 Charlotte Hwy Ste 100&101",
            "address_purpose": "LOCATION",
            "city": "Fort Mill",
            "state": "SC",
            "postal_code": "297077900",
            "country_code": "US",
            "telephone_number": "803-973-4183",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROARK",
        "first_name": "CASEY",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-02-17",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "11765",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P21928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rla Infinity Home Care
• Deanna Roach
• Elijah Roach, LCAS A
• Michael Judson Roach, MD
• Alexandra Simone Roak, PHD
• Justyn Roark, OTR
• Alexis Robaczewski
• Kiley Ann Robb, PT, DPT
• Robbie Mae & Associates, LLC
• Abigail Robbins

• Physical Therapist in Charlotte, NC
• Providers in Charlotte, 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 Feb 24, 2023; 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.