PIVOT PHYSICAL THERAPY OF MID ATLANTIC, LLC
Complete NPI Record 1871010504
Physical Therapist in Wilmington, DE
Active since August 24, 2017
Complete NPI Dataset
This page contains the complete raw NPPES record for Pivot Physical Therapy Of Mid Atlantic, Llc (NPI 1871010504), a physical therapist organization in Wilmington, DE. All 34 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1871010504 Field 1/34
- 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 Field 2/34
- 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: Not available Field 3/34
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: DYNAMIC THERAPY SERVICES LLC Field 4/34
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: PIVOT PHYSICAL THERAPY OF MID ATLANTIC, LLC Field 5/34
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 3 Field 6/34
- 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 Mailing Address: 2122 YORK RD STE 300 Field 7/34
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: OAK BROOK Field 8/34
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: IL Field 9/34
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 605231925 Field 10/34
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/34
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 2522483313 Field 12/34
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider First Line Business Practice Location Address: 3401 BRANDYWINE PKWY STE 201 Field 13/34
- 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: WILMINGTON Field 14/34
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: DE Field 15/34
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 198031554 Field 16/34
- 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 Field 17/34
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 3024790880 Field 18/34
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 3024790550 Field 19/34
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: BROUGHTON Field 22/34
- 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: TASHEDA Field 23/34
- The first name of the authorized official.
- Authorized Official Title or Position: MANAGER, CREDENTIALING Field 24/34
- The title or position of the authorized official.
- Authorized Official Telephone Number: 2522483313 Field 25/34
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 225100000X Field 26/34
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 27/34
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 225X00000X Field 28/34
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 2: N Field 29/34
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: N Field 30/34
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Authorized Official Credential Text: PESC Field 31/34
- The professional credential(s) of the authorized official listed on the provider's NPI record. Examples include MD (Doctor of Medicine), DO (Doctor of Osteopathy), RN (Registered Nurse), DDS (Doctor of Dental Surgery), PhD, or other recognized designations that reflect the official's qualifications.
- Healthcare Provider Taxonomy Group 1: 193400000X MULTIPLE SINGLE SPECIALTY GROUP Field 32/34
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 2: 193400000X MULTIPLE SINGLE SPECIALTY GROUP Field 33/34
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
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