Jesse McCoy Pietroburgo, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT39083 Issued in FL

Practice address

739A S Nova Rd
Ormond Beach, FL 32174-7332

Phone

(386) 671-2626

NPI assigned

Aug 6, 2022

Last updated

Aug 6, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University Rehabilitation, LLCGroup PAC ID 6901884519, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

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.

• University Rehabilitation, LLC

  dba Premier Physical Therapy and Sports Medicine

  • Physical Therapist
  • Port Orange, FL
  • NPI 1811185291
  Medicare reassignment Care Compare group NPD
• Florehab Center LLC

  • Physical Therapist
  • Ormond Beach, FL
  • NPI 1730418237
  Medicare reassignment NPD

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

{
    "created_epoch": "1659744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659744000000",
    "number": "1902533169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 E VILLA CAPRI CIR APT D",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327247859",
            "telephone_number": "573-529-5084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "739A S NOVA RD",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321747332",
            "telephone_number": "386-671-2626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIETROBURGO",
        "first_name": "JESSE",
        "middle_name": "MCCOY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-06",
        "last_updated": "2022-08-06",
        "certification_date": "2022-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT39083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Physicians Ambulatory Surgery Center Inc
• Charles Lawrence Piazza Jr., DPT, ATC, MTC
• Jill Anne Piazza, PT
• Emmalynn I Pier, LMT
• Meg Pierce, PA
• Kelsey Lauren Pilati-Willis, DC
• G. Michael Pilcher, PHD, LMHC
• Stacia L. Pilcher, LMT
• Sergio N/a Pineiro Jr., D.O.
• Pinnacle Dentistry

• Physical Therapist in Ormond Beach, FL
• Providers in Ormond Beach, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2022; 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.