Individual provider Active NPI

Chase Tucker, D.P.T

  • Physical Therapist
  • Lake Wylie, SC
National Provider Identifier
1902282882
Registry record updated Apr 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
7852 Issued in SC
Practice address
439 Channel Rd
Suite 102
Lake Wylie, SC 29710-6102
Phone
(803) 746-7800
NPI assigned
Aug 3, 2015
Last updated
Apr 11, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 7852 SC Primary
Physical Therapist 225100000X P17456 NC

Addresses

Primary practice location

439 Channel Rd
Suite 102
Lake Wylie, SC 29710-6102

Mailing address

PO Box 412066
Boston, MA 02241-2066

Other practice location 1

10635 Park Rd Ste D
Charlotte, NC 28210-8408
Phone (980) 890-3233

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150921003115 SC Practitioner - Physical Therapist in Private Practice 1759698962 Reassigns benefits to 1 organization
I20240312001341 NC Practitioner - Physical Therapist in Private Practice 1759698962 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab Focus, Inc.Group PAC ID 5890851406, 39 clinicians
Ivyrehab North Carolina LLCGroup PAC ID 8820336324, 158 clinicians

Practice addresses (Care Compare)

439 Channel Rd
Suite 102
Lake Wylie, SC 29710-6101
Phone (803) 746-7800

4833 Berewick Town Ctr Dr
Suite H
Charlotte, NC 28278-6721
Phone (980) 880-6780

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7852SCMDPharmacist
P17456NCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Focus, Inc. Physical Therapist CurrentSince Jul 29, 2015 Accepting new patients
Ivyrehab North Carolina LLC CurrentSince Feb 1, 2024 Accepting new patients
Ivyrehab North Carolina LLC Physical Therapist CurrentSince Feb 1, 2024 Accepting new patients
Ivyrehab Focus, Inc. CurrentSince Jul 29, 2015 Accepting new patients

Locations

10635 Park Rd
Ste D
Charlotte, NC 28210
Phone (980) 890-3233

2016 Ayrsley Town Blvd
Ste E
Charlotte, NC 28273
Phone (980) 272-5771

4833 Berewick Town Center Dr
Ste H
Charlotte, NC 28278
Phone (980) 880-6780

5960 Fairview Rd
Ste 250
Charlotte, NC 28210
Phone (980) 224-7958

9216 Ardrey Kell Rd
Ste 300
Charlotte, NC 28277
Phone (980) 556-7330

4514 Old Monroe Rd
#B
Indian Trail, NC 28079
Phone (980) 890-8850

130 Crisanto Ave
Ste A
Fort Mill, SC 29715
Phone (803) 487-5638

439 Channel Rd
Ste 102
Lake Wylie, SC 29710
Phone (619) 977-0480

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1438560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712793600000",
    "number": "1902282882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 412066",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022412066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "439 CHANNEL RD",
            "address_2": "SUITE 102",
            "city": "LAKE WYLIE",
            "state": "SC",
            "postal_code": "297106102",
            "telephone_number": "803-746-7800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10635 Park Rd Ste D",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282108408",
            "country_code": "US",
            "telephone_number": "980-890-3233",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "CHASE",
        "name_prefix": "Dr.",
        "credential": "D.P.T",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-03",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "7852",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P17456",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Wylie, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; 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.