Active NPI
Tony Nguyen, PTA
- Physical Therapy Assistant
- St Simons Is, GA
National Provider Identifier
1104241454
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA003210
- Practice address
- 124 Island Professional Park
St Simons Is, GA 31522-2879 - Phone
- (912) 638-1444
- Fax
- (912) 638-0077
- NPI assigned
- Feb 24, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA003210 | GA | Primary |
Addresses
Primary practice location
124 Island Professional Park
St Simons Is, GA 31522-2879
Mailing address
PO Box 949
Rome, GA 30162-0949
Phone (706) 236-2774
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA003210 | GA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393200000000",
"number": "1104241454",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 949",
"city": "ROME",
"state": "GA",
"postal_code": "301620949",
"telephone_number": "706-236-2774",
"fax_number": "706-236-2783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 ISLAND PROFESSIONAL PARK",
"city": "ST SIMONS IS",
"state": "GA",
"postal_code": "315222879",
"telephone_number": "912-638-1444",
"fax_number": "912-638-0077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "TONY",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-02-24",
"last_updated": "2014-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "GA",
"license": "PTA003210",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Simons Is, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.