Individual provider Active NPI

Laura Harris Gwynn, MPT

  • Physical Therapist
  • Norfolk, VA
National Provider Identifier
1821170267
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305004289 Issued in VA
Practice address
2200 Colonial Avenue Suite 2
Norfolk, VA 23517
Phone
(757) 622-8777
NPI assigned
Oct 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305004289 VA Primary

Addresses

Primary practice location

2200 Colonial Avenue Suite 2
Norfolk, VA 23517

Mailing address

204 White Dogwood Drive
Chesapeake, VA 23322-4167
Phone (757) 819-7827

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, DC, MD3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20111005000859 VA Practitioner - Physical Therapist in Private Practice 4688846124 Reassigns benefits to 2 organizations
I20151015000710 DC Practitioner - Physical Therapist in Private Practice 4688846124 Reassigns benefits to 1 organization
I20151211000592 MD Practitioner - Physical Therapist in Private Practice 4688846124 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fox Rehabilitation Services LLCGroup PAC ID 1355347410, 304 clinicians

Practice addresses (Care Compare)

9885 Greenbelt Rd
Lanham, MD 20706-2302
Phone (877) 407-3422

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2305004289VAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Fox Rehabilitation Services LLC Physical Therapist CurrentSince Sep 1, 2015 Accepting new patients
Fox Rehab PT MD LLC Physical Therapist CurrentSince Oct 14, 2015 Accepting new patients
Kirven Orthopedic Group, P.C. CurrentSince Aug 1, 2011 Accepting new patients

Locations

11665 Doolittle Dr
Waldorf, MD 20602
Phone (301) 638-4100

7 Carnegie Plz
Cherry Hill, NJ 08003

200 Medical Pkwy
Ste 111
Chesapeake, VA 23320
Phone (757) 547-0855

5701 Cleveland St
Ste 600
Virginia Beach, VA 23462
Phone (757) 963-6507

20 E Piccadilly St
Ste 1114
Winchester, VA 22601

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821170267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 WHITE DOGWOOD DRIVE",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233224167",
            "telephone_number": "757-819-7827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 COLONIAL AVENUE SUITE 2",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "23517",
            "telephone_number": "757-622-8777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWYNN",
        "first_name": "LAURA",
        "middle_name": "HARRIS",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305004289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.