Jennifer Bailey, PHYSICAL THERAPISTJE
Individual provider Active NPI Physical Therapist · Villa Rica, GA
NPI 1003437682 · NPPES record last updated May 5, 2020
Key facts
- NPI
- 1003437682
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT006126 (GA)
- Practice address
- 423 Twin Lakes Dr
Villa Rica, GA 30180-5505 - Phone
- (770) 865-3484
- NPI assigned
- May 5, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250701000688 | GA | Practitioner - Physical Therapist in Private Practice | 2365955515 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT006126 | GA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| RWW Senior Living Outpatient Rehab Services, LLC | Physical Therapist | Current |
Accepting new patients |
| RWW Senior Living Outpatient Rehab Services, LLC | Physical Therapist | Current |
Accepting new patients |
Locations
1860 Atkinson Rd
Lawrenceville, GA 30043
Phone (706) 948-2773
805 N Whittington Pkwy
Northfield, KY 40222
Phone (502) 627-7000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT006126 | GA | Yes |
Addresses
Primary practice location
423 Twin Lakes Dr
Villa Rica, GA 30180-5505
Mailing address
423 Twin Lakes Dr
Villa Rica, GA 30180-5505
Phone (770) 865-3484
Other providers in Villa Rica, GA
- Urooj Ather
- Atrianon, LLC
- Edwidge Azor-Antoine
- Elizabeth Grace Babcock
- George W Bailey
- Erika Ballard
- Bankhead Chiropractic
- Golden Barnett III
- John T Bassett V
- Brittany A Bates
All providers in Villa Rica, GA · Physical Therapist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.