Jennifer Stutts Pack, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P17694 Issued in NC

Practice address

4002 Executive Park Blvd Ste 800
Southport, NC 28461-9069

Phone

(910) 477-6236

Fax

(910) 477-6357

NPI assigned

Feb 14, 2018

Last updated

Feb 14, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Pack Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Peak Performance Sports and Physical Therapy, LLC

  • Physical Therapist
  • New Bern, NC
  • NPI 1194714063
  NPD

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

{
    "created_epoch": "1518566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518566400000",
    "number": "1932609187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4002 EXECUTIVE PARK BLVD STE 800",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284619069",
            "telephone_number": "910-477-6236",
            "fax_number": "910-477-6357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4002 EXECUTIVE PARK BLVD STE 800",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284619069",
            "telephone_number": "910-477-6236",
            "fax_number": "910-477-6357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUTTS PACK",
        "first_name": "JENNIFER",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-14",
        "last_updated": "2018-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P17694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "PACK",
            "credential": "PT, DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Southport, NC
• Providers in Southport, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.