Active NPI
Sophia Antonia Blue, LPTA
- Physical Therapy Assistant
- Austell, GA
National Provider Identifier
1124502679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 001390
- Practice address
- 2130 Anderson Mill Rd
Austell, GA 30106-1806 - Phone
- (770) 941-8813
- NPI assigned
- Sep 20, 2018
- Sex
- Female
- 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 | 001390 | GA | Primary |
Addresses
Primary practice location
2130 Anderson Mill Rd
Austell, GA 30106-1806
Mailing address
4291 W Linda Dr
Douglasville, GA 30134-2617
Phone (678) 576-9652
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 |
|---|---|---|---|
| 001390 | GA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537401600000",
"number": "1124502679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4291 W LINDA DR",
"city": "DOUGLASVILLE",
"state": "GA",
"postal_code": "301342617",
"telephone_number": "678-576-9652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2130 ANDERSON MILL RD",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301061806",
"telephone_number": "770-941-8813"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLUE",
"first_name": "SOPHIA",
"middle_name": "ANTONIA",
"name_prefix": "Miss",
"credential": "LPTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-20",
"last_updated": "2018-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "GA",
"license": "001390",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.