Active NPI
Kevin E. Brueilly, PT, PHD
- Physical Therapist
- Charlotte, NC
National Provider Identifier
1780052258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 14038
- Practice address
- 1100 Blythe Blvd
Charlotte, NC 28203-5814 - Phone
- (704) 355-7760
- NPI assigned
- Sep 14, 2015
- Sex
- Male
- 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 | 14038 | NC | Primary |
Addresses
Primary practice location
1100 Blythe Blvd
Charlotte, NC 28203-5814
Mailing address
2702 Creek Manor Dr
Waxhaw, NC 28173-4116
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14038 | NC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442188800000",
"number": "1780052258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2702 CREEK MANOR DR",
"city": "WAXHAW",
"state": "NC",
"postal_code": "281734116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 BLYTHE BLVD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282035814",
"telephone_number": "704-355-7760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUEILLY",
"first_name": "KEVIN",
"middle_name": "E.",
"name_prefix": "Dr.",
"credential": "PT, PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-14",
"last_updated": "2015-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "14038",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.