NPIMap

Organization Active NPI

Soar Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Woodstock, GA
National Provider Identifier
1083861785
Registry record updated Mar 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT009114 Issued in GA
Legal business name
SOAR PHYSICAL THERAPY, INC
Practice address
6884 Hickory Flat Hwy
Woodstock, GA 30188-3229
Phone
(770) 704-8244
Fax
(770) 704-8264
NPI assigned
Aug 25, 2008
Last updated
Mar 23, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Burton William Stevens Jr., PT, DPT, SCS, ATCNPI 1093746638
Title
Physical Therapist/ Owner
Phone
(770) 704-8244

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PT009114 GA Primary

Addresses

Primary practice location

6884 Hickory Flat Hwy
Woodstock, GA 30188-3229

Mailing address

6884 Hickory Flat Hwy
Woodstock, GA 30188-3229
Phone (770) 704-8244

Other identifiers 1

IdentifierTypeStateIssuer
511G701183OtherGAMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090223000316 GA Part B Supplier - Clinic/Group Practice 0941365100 Receives reassigned benefits from 23 practitioners
Practice locations: Marietta, GA; Woodstock, GA
O20170407002040 GA DME Supplier - Independently-Practicing Occupational Therapist 0941365100 Practice locations: Woodstock, GA

National Provider Directory

National Provider Directory

Locations

3342 Trickum Rd
Ste D
Woodstock, GA 30188
Phone (678) 401-5772

4477 Towne Lake Pkwy
Ste 120
Woodstock, GA 30189
Phone (678) 880-9597

6884 Hickory Flat Hwy
Woodstock, GA 30188
Phone (770) 704-8244

7200 Hickory Flat Hwy
Woodstock, GA 30188
Phone (678) 619-2078

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458691200000",
    "number": "1083861785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6884 HICKORY FLAT HWY",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301883229",
            "telephone_number": "770-704-8244",
            "fax_number": "770-704-8264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6884 HICKORY FLAT HWY",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301883229",
            "telephone_number": "770-704-8244",
            "fax_number": "770-704-8264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOAR PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-25",
        "last_updated": "2016-03-23",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "BURTON",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/ OWNER",
        "authorized_official_telephone_number": "770-704-8244",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PT, DPT, SCS, ATC"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "GA",
            "license": "PT009114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "511G701183",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodstock, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.