Independence Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

INDEPENDENCE PHYSICAL THERAPY LLC

Practice address

762 Independence Blvd Ste B
Virginia Beach, VA 23455-6200

Phone

(757) 497-7575

Fax

(757) 490-1795

NPI assigned

Mar 1, 2022

Organization subpart

Yes

Parent organization

INDEPENDENCE PHYSICAL THERAPY LLCAs reported in NPPES

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

Authorized official

Name

Miss Gladdys O Pasco

Title

Office Manager

Phone

(757) 497-7575

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Part of

Independence Physical Therapy LLC

Locations

Practitioners 5

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.

• Robert J Maroon, PT

  • Physical Therapist
  • Norfolk, VA
  • NPI 1386627339
  Medicare reassignment NPD
• Jessica L Taylor, PT, DPT

  • Physical Therapist
  • Chesapeake, VA
  • NPI 1598908535
  Medicare reassignment NPD
• Kayla Rae Fuller, LPTA

  • Physical Therapy Assistant
  • Virginia Beach, VA
  • NPI 1245921345

  Single Specialty

  NPD
• William P Grant, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Virginia Beach, VA
  • NPI 1982706685
  NPD
• Jacqueline A Santiago, PT, DPT

  • Physical Therapist
  • Chesapeake, VA
  • NPI 1194238444
  NPD

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

{
    "created_epoch": "1646092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646092800000",
    "number": "1750037610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "762 INDEPENDENCE BLVD STE B",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234556200",
            "telephone_number": "757-497-7575",
            "fax_number": "757-490-1795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "762 INDEPENDENCE BLVD STE B",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234556200",
            "telephone_number": "757-497-7575",
            "fax_number": "757-490-1795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE PHYSICAL THERAPY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INDEPENDENCE PHYSICAL THERAPY LLC",
        "enumeration_date": "2022-03-01",
        "last_updated": "2022-03-01",
        "certification_date": "2022-02-18",
        "status": "A",
        "authorized_official_last_name": "PASCO",
        "authorized_official_first_name": "GLADDYS",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "757-497-7575",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "CONNECTURL",
            "affiliation": "N",
            "endpointDescription": "CONNECT URL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "762 Independence Blvd Ste B",
            "city": "Virginia Beach",
            "state": "VA",
            "country_code": "US",
            "postal_code": "234556200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.drgrantdiabeticfeet.com/",
            "affiliation": "N",
            "endpointDescription": "Website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "website",
            "address_1": "760 Independence Blvd Ste B",
            "city": "Virginia Beach",
            "state": "VA",
            "country_code": "US",
            "postal_code": "234556206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nadeem Inayet, MD
• Inclusive Children Care LLC,
• Indelible Management Solutions
• Independence Child Therapy Services LLC
• Independence Family Medicine
• Independence Therapy Center P C
• Independent Living Ambulatory and Wheelchair Services LLC
• Independent Pathway Services LLC
• Independent Pathways LLC
• Indian River Psychological Associates, P.C.

• Physical Therapist in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; 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.