PROVIDENCE PHYSICAL THERAPY & PERFORMANCE, LLC. (NPI# 1104279520) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104279520 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICAL THERAPY & PERFORMANCE, LLC. |
| Practice Address |
107 Live Oak St Tabor City NC 28463-2042 |
| Mailing Address |
Po Box 219 Tabor City NC 28463-0219 |
| Practice Telephone | 2529169949 |
| Mailing Telephone | 9103773146 |
| Mailing Fax Number | 9103773277 |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2017-02-06 |
| Authorized Official Name | DR. KEVIN BRIAN BULLARD (PHYSICAL THERAPIST/OWNER/MANAGER) |
| Authorized Official Telephone | 2529169949 |
| Authorized Official Credential | DPT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
10244 | NC | Ambulatory Health Care Facilities |
| Street Address |
107 LIVE OAK ST |
| City | TABOR CITY |
| State | NC |
| Zip Code | 28463-2042 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639111594 | Kevin B Bullard | Physical Therapist | 107 Live Oak St, Ste C, Tabor City, NC 28463-2043 | 2006-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992347157 | Mh Medical Services, PC | Nurse Practitioner | 1107 East 5th St., Tabor City, NC 28463 | 2019-10-09 |
| 1962658237 | Generations Family Medicine | Family Medicine | 106 Tabor Crossing, Tabor City, NC 28463 | 2008-08-18 |
| 1942404637 | Coming Together Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 5112 Chadbourn Hwy, Chadbourn, NC 28463 | 2007-06-14 |
| 1568509826 | Dameron Drug Store, Inc | Durable Medical Equipment & Medical Supplies | 100 S Main St., Tabor City, NC 28463 | 2007-01-30 |
| 1871560631 | Dameron Drug Store Inc | Durable Medical Equipment & Medical Supplies | 100 S Main St, Tabor City, NC 28463 | 2006-03-01 |
| 1497972996 | Edward Mcclendon IIi | Dentist | 501 Hickman Rd., Tabor City, NC 28463-0536 | 2007-04-19 |
| 1609105592 | Premier Behavioral Services Inc | Community/Behavioral Health | 104 Industrial Park Road, Tabor City, NC 28463-1665 | 2009-12-23 |
| 1467568337 | Twin States Vital Care, Inc. | Durable Medical Equipment & Medical Supplies | 218b S Main St, Tabor City, NC 28463-1904 | 2006-08-22 |
| 1174639041 | Medicine Mart Ltc, LLC | Pharmacy | 214 S Main St, Tabor City, NC 28463-1904 | 2006-08-22 |
| 1912013889 | Tabor City Medicine Mart, Inc | Pharmacy | 220 S Main St, Tabor City, NC 28463-1904 | 2006-08-22 |
| Find all providers in zip 28463 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801496757 | North Carolina Physical Therapy | Clinic/Center | 223 E Chatham St Ste 101, Cary, NC 27511-3475 | 2020-10-29 |
| 1750988861 | Homefront Physical Therapy, LLC | Clinic/Center | 100 Fullard Dr, Sneads Ferry, NC 28460-9530 | 2020-10-02 |
| 1861009144 | Radiance Physical Therapy LLC | Clinic/Center | 9 Richmond Ct, Durham, NC 27713-8376 | 2020-09-30 |
| 1386250124 | Nicol Chiropractic Center | Clinic/Center | 7011 Fayetteville Rd Ste 106b, Durham, NC 27713-7745 | 2020-09-17 |
| 1295349231 | All Natural Female LLC | Clinic/Center | 10314 Kirkmont Dr, Charlotte, NC 28269-6219 | 2020-09-08 |
| 1538773064 | Congruency Therapy & Wellness LLC | Clinic/Center | 5045 Strawberry Hill Dr Apt D, Charlotte, NC 28211-4535 | 2020-09-02 |
| 1093329617 | Begin With Breath, LLC | Clinic/Center | 37 Hampden Rd, Asheville, NC 28805-2421 | 2020-09-01 |
| 1225641020 | Flo Physical Therapy & Performance LLC | Clinic/Center | 13959 Tom Short Rd, Marvin, NC 28173-5300 | 2020-08-31 |
| 1689286122 | 2662 Pursuits LLC | Clinic/Center | 279 Paragon Pkwy, Clyde, NC 28721-8509 | 2020-08-17 |
| 1255958930 | Rise Physical Therapy LLC | Clinic/Center | 3710 Exchange Glenwood Pl Apt 346, Raleigh, NC 27612-4853 | 2020-06-29 |
| Find all providers with the same taxonomy | ||||
| City | TABOR CITY |
| Zip Code | 28463 |
Please comment or provide details below to improve the information on PROVIDENCE PHYSICAL THERAPY & PERFORMANCE, LLC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.