NPIMap

Organization Active NPI

Greenville Peak Performance Sports & Physical Therapy, LLC

  • Physical Therapist
  • Winterville, NC
National Provider Identifier
1962603266
Registry record updated Apr 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
GREENVILLE PEAK PERFORMANCE SPORTS & PHYSICAL THERAPY, LLC
Practice address
740 W Fire Tower Rd
Suite 113
Winterville, NC 28590-8411
Phone
(252) 636-9800
Fax
(252) 636-1945
NPI assigned
May 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2018

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

Authorized official

Name
Joseph Laurent
Title
Authorized Official
Phone
(616) 356-5011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

740 W Fire Tower Rd
Suite 113
Winterville, NC 28590-8411

Mailing address

607 Dewey Ave NW
Suite 300
Grand Rapids, MI 49504-7335
Phone (616) 356-5000

Other identifiers 2

IdentifierTypeStateIssuer
019E8OtherNCBCBSNC
7200527MedicaidNC

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

740 W Fire Tower Rd
Ste 113
Winterville, NC 28590
Phone (252) 329-8800

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525046400000",
    "number": "1962603266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 DEWEY AVE NW",
            "address_2": "SUITE 300",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495047335",
            "telephone_number": "616-356-5000",
            "fax_number": "616-356-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 W FIRE TOWER RD",
            "address_2": "SUITE 113",
            "city": "WINTERVILLE",
            "state": "NC",
            "postal_code": "285908411",
            "telephone_number": "252-636-9800",
            "fax_number": "252-636-1945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE PEAK PERFORMANCE SPORTS & PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2018-04-30",
        "status": "A",
        "authorized_official_last_name": "LAURENT",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "616-356-5011"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "019E8",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7200527",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winterville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 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.