CONNOR PENDERGRAFT (DPT) – Physical Therapist, NPI 1497634877

CONNOR PENDERGRAFT (DPT) is a healthcare provider. based in Johnson city, Tennessee. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials DPT. They hold a License No. 16713 (TN). The NPI Number for CONNOR PENDERGRAFT (DPT) is 1497634877

Main info

Male
1 Year Of Experience
Accepts Medicare Assignment
Name
CONNOR PENDERGRAFT (DPT)
NPI
1497634877
Phone
(423) 804-1020
Address
2041 Hamilton Pl
Enumeration Date
29 August 2025
Last Update Date
5 May 2026

Doctor Profile

Medical School Name
EAST TENNESSEE STATE UNIVERSITY QUILLEN COLLEGE OF MEDICINE
Secondary Phone
4233177772
Graduation Year
2025 (1 year ago)
PAC ID
8921503053
Group Practice PAC ID
5890117469
Professional Enrollment ID
I20250927000150
Address ID
TN378132237MO325XXBLVD400
Data current as of
3 June 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience24
Completeness85
Years active:0State licenses:1Digital endpointsOther names

2,334 PHYSICAL THERAPIST IN PRIVATE PRACTICE in TN

Provider Addresses for CONNOR PENDERGRAFT (DPT)

  • 2041 Hamilton Pl

    Johnson City, TN 376047920

    Phone: (423) 804-1020

    Fax: (423) 317-7773

    Type: Location

  • 325 W MORRIS BLVD STE B

    MORRISTOWN, TN 378132237

    Phone: (423) 317-7772

    Fax: (423) 317-7773

    Type: Mailing

  • 2041 HAMILTON PL

    JOHNSON CITY, TN 376047920

    Phone: (423) 804-1020

    Fax: (423) 317-7773

    Type: Location

  • 1021 W OAKLAND AVE STE 310

    JOHNSON CITY, TN 376042192

    Phone: (423) 952-2111

    Type: Mailing

  • 295 BRISTOL EAST RD

    BRISTOL, VA 242025532

    Phone: (276) 591-5484

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-09-27

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250927000150IPhysical Therapist In Private PracticeTNTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 37604)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5890117469View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeNY
Occupational Therapist In Private PracticeTN
Occupational Therapist In Private PracticeOR
Occupational Therapist In Private PracticeTN
Physical Therapist In Private PracticeTN
Physical Therapist In Private PracticeTN
-TN
Physical Therapist In Private PracticeTN
-TN
Occupational Therapist In Private PracticeTN

Reviews

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Frequently asked questions

What is the 10-digit NPI for CONNOR PENDERGRAFT (DPT)?
CONNOR PENDERGRAFT (DPT) — NPI 1497634877 — is the standard way to identify this listing.
Does CMS list CONNOR PENDERGRAFT (DPT) as active?
Yes — CONNOR PENDERGRAFT (DPT) is active in the NPI listing used on this page.
What taxonomy line describes CONNOR PENDERGRAFT (DPT)?
For research purposes, treat CONNOR PENDERGRAFT (DPT) as Physical Therapist in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for CONNOR PENDERGRAFT (DPT)?
CONNOR PENDERGRAFT (DPT)'s geographic hint is Johnson City, Tennessee in our summary view.
Is the information about CONNOR PENDERGRAFT (DPT) up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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