Physically Empowered Therapy & Wellness

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT001665 Issued in GA

Legal business name

PHYSICALLY EMPOWERED THERAPY & WELLNESS

Doing business as

Tri-Cities Sports Medicine and Rehab

Practice address

2300 Sugarleaf Trail
Hampton, GA 30228

Phone

(770) 203-5144

NPI assigned

Jul 11, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Jeancarlo Alencastro, ATC/L

Title

Clinic Owner

Phone

(770) 203-5144

Specialties & licenses 1

Addresses

Other names 1

• Tri-Cities Sports Medicine and Rehab Doing business as

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

{
    "created_epoch": "1310342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533081600000",
    "number": "1114215233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 SUGARLEAF TRAIL",
            "city": "HAMPTON",
            "state": "GA",
            "postal_code": "30228",
            "telephone_number": "770-203-5144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 SUGARLEAF TRAIL",
            "city": "HAMPTON",
            "state": "GA",
            "postal_code": "30228",
            "telephone_number": "770-203-5144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICALLY EMPOWERED THERAPY & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-11",
        "last_updated": "2018-08-01",
        "status": "A",
        "authorized_official_last_name": "ALENCASTRO",
        "authorized_official_first_name": "JEANCARLO",
        "authorized_official_title_or_position": "CLINIC OWNER",
        "authorized_official_telephone_number": "770-203-5144",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ATC/L"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT001665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tri-Cities Sports Medicine and Rehab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tri-Cities Sports Medicine and Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Athletic Trainer in Hampton, GA
• Providers in Hampton, GA by specialty
• Athletic Trainer in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; 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.