Individual provider Active NPI

Gary Charles Of, PT

  • Physical Therapist
  • Indian Trail, NC
National Provider Identifier
1861511461
Registry record updated May 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
9608 Issued in NC
Practice address
6048 W Highway 74
Indian Trail, NC 28079-3591
Phone
(980) 993-5540
Fax
(980) 993-5542
NPI assigned
Mar 28, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2025

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 9608 NC Primary

Addresses

Primary practice location

6048 W Highway 74
Indian Trail, NC 28079-3591

Mailing address

6048 W Highway 74
Indian Trail, NC 28079-3591
Phone (980) 993-5540

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251217004595 NC Practitioner - Physical Therapist in Private Practice 8729573787 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atrium Health Specialty Network IncGroup PAC ID 5193245801, 248 clinicians

Practice addresses (Care Compare)

3030 Randolph Rd
Suite 105a
Charlotte, NC 28211-1365
Phone (704) 512-4420

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
017276NYMDMental Health Counselor
9608NCMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Atrium Health Specialty Network Inc Physical Therapist CurrentSince Aug 31, 2025 Accepting new patients

Locations

3030 Randolph Rd
Ste 105A
Charlotte, NC 28211
Phone (704) 512-4420

4525 Cameron Valley Pkwy
Charlotte, NC 28211
Phone (704) 355-5100

6048 W Highway 74
Indian Trail, NC 28079
Phone (980) 993-5540

Organizations & group practices 1

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": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747180800000",
    "number": "1861511461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6048 W HIGHWAY 74",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280793591",
            "telephone_number": "980-993-5540",
            "fax_number": "980-993-5542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6048 W HIGHWAY 74",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280793591",
            "telephone_number": "980-993-5540",
            "fax_number": "980-993-5542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OF",
        "first_name": "GARY",
        "middle_name": "CHARLES",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-28",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "9608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indian Trail, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2025; 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.