Active NPI
Shante Jasmine Benbow, PTA
- Physical Therapy Assistant
- Cartersville, GA
National Provider Identifier
1124603329
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA003848
- Practice address
- 78 Opal St
Cartersville, GA 30120-2848 - Phone
- (770) 382-6120
- NPI assigned
- Mar 10, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | PTA003848 | GA | Primary |
Addresses
Primary practice location
78 Opal St
Cartersville, GA 30120-2848
Mailing address
500 Sycamore LN Apt 108
Woodstock, GA 30188-7320
Phone (229) 583-2318
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 |
|---|---|---|---|
| PTA003848 | GA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615334400000",
"number": "1124603329",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 SYCAMORE LN APT 108",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301887320",
"telephone_number": "229-583-2318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "78 OPAL ST",
"city": "CARTERSVILLE",
"state": "GA",
"postal_code": "301202848",
"telephone_number": "770-382-6120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENBOW",
"first_name": "SHANTE",
"middle_name": "JASMINE",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-03-10",
"last_updated": "2021-03-10",
"certification_date": "2021-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "GA",
"license": "PTA003848",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cartersville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.