NPI |
1528290194 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
IDEAS INVESTED, L.L.C. |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Other Organization Name |
TRUE ABILITIES PHYSICAL THERAPY |
Other name by which the organization provider is or has been known. |
Provider Other Organization Name Type Code |
3 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider First Line Business Practice Location Address |
211 W WILLIAMS ST |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
BURGAW |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
NC |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
284255331 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
9107899568 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
8/17/2009 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
3/2/2010 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
BANNERMAN-LEE |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
TALISA |
The first name of the authorized official. |
Authorized Official Middle Name |
R |
The middle name of the authorized official. |
Authorized Official Title or Position |
OWNER/PHYSICAL THERAPIST |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Authorized Official Telephone Number |
9107899568 |
The last name of the provider. If the provider is an individual, this is the legal name. |
Healthcare Provider Taxonomy Code 1 |
225100000X |
The first name of the provider, if the provider
is an individual. |
Provider License Number 1 |
10066 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider License Number State Code 1 |
NC |
The city name in the location address of the provider being identified. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Authorized Official Name Prefix Text |
DR. |
The country code in the location address of the provider being identified. |
Authorized Official Credential Text |
PT, DPT |
The telephone number associated with the location address of the provider being identified. |
Healthcare Provider Taxonomy Group 1 |
193400000X SINGLE SPECIALTY GROUP |
The fax number associated with the location
address of the provider being identified. |