John Degenaro, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA000612 Issued in GA

Practice address

1765 Old West Broad St
Athens, GA 30606-2853

Phone

(706) 549-1663

Fax

(706) 546-8792

NPI assigned

Oct 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654646400000",
    "number": "1104900869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1765 OLD WEST BROAD ST BLDG 2-200",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062887",
            "telephone_number": "706-549-1663",
            "fax_number": "706-546-8792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1765 OLD WEST BROAD ST",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062853",
            "telephone_number": "706-549-1663",
            "fax_number": "706-546-8792"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3440 Highway 81",
            "address_purpose": "LOCATION",
            "city": "Loganville",
            "state": "GA",
            "postal_code": "300529112",
            "country_code": "US",
            "telephone_number": "770-554-5009",
            "fax_number": "706-546-8792",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEGENARO",
        "first_name": "JOHN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA000612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH NUMBER",
            "identifier": "14340957",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Athens, GA
• Providers in Athens, GA by specialty
• Physical Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.