Southern Pines Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2089 Issued in NC

Legal business name

SOUTHERN PINES PHYSICAL THERAPY, LLC

Practice address

210 S Bennett St
Southern Pines, NC 28387-5402

Phone

(910) 692-8269

NPI assigned

Jun 1, 2006

Organization subpart

No

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

Authorized official

Name

Susan G Stovall, PT

Title

Partner

Phone

(910) 692-8269

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962449504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 S BENNETT ST",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283875402",
            "telephone_number": "910-692-8269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S BENNETT ST",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283875402",
            "telephone_number": "910-692-8269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PINES PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STOVALL",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "910-692-8269",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "2089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC GROUP",
            "identifier": "015AG",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST CAROLINA GROUP",
            "identifier": "FH60000150",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiara Smith
• Megan Soros
• Jena Leigh Southerland, MS CCC-SLP
• Southern Pines Chiropractic, P.a.
• Southern Pines Diagnostic Imaging, LLC
• Southern Pines Prescription Shop Inc
• Southern Pines Surgery Center, LLC
• Southern Pines Women'S Health Center PC
• Southern Speech Diagnostics PLLC
• Ashley M Sparks, LCSW-A

• Physical Therapist in Southern Pines, NC
• Providers in Southern Pines, 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 Aug 22, 2020; 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.