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NPI 1417562141ActiveIndividual· Physical Therapist· Pooler, GA
Physical Therapist with Beaufort Orthopaedic Sports and Spine Center LLC, practicing in Pooler, Georgia. Medicare paid $36,961 for services to 66 patients in 2024.
Overview
| NPI | 1417562141 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | No |
| NPI issued | Sep 10, 2020 |
| Last updated in NPPES | Jul 14, 2026 |
| Certified by provider | Jul 14, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | 10413 | SC |
| Physical Therapist | 225100000X | PT016325 | GA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physical Therapist in Private Practice (GA); Practitioner - Physical Therapist in Private Practice (SC) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 66 |
|---|---|
| Services billed | 1,739 across 10 procedure codes |
| Paid by Medicare | $36,961 |
Education and affiliations
| Graduation year | 2020 |
|---|---|
| Medicare specialty | Physical Therapist In Private Practice |
Medical group
- Beaufort Orthopaedic Sports and Spine Center LLCHilton Head Island, SC · 44 clinicians
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