NPIMap

Organization Active NPI

Therapy Trails of Evans

  • Multi-Specialty Clinic/Center
  • Evans, GA
National Provider Identifier
1124677919
Registry record updated Sep 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
THERAPY TRAILS OF EVANS
Practice address
536 Grand Slam Dr Ste D
Evans, GA 30809-8045
Phone
(706) 854-8434
Fax
(706) 854-8435
NPI assigned
Sep 5, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2019

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

Authorized official

Name
Elizabeth PeavyNPI 1376942508
Title
Owner/SLP
Phone
(706) 842-3330

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251P0200X
Pediatric Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0200X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

536 Grand Slam Dr Ste D
Evans, GA 30809-8045

Mailing address

536 Grand Slam Dr Ste D
Evans, GA 30809-8045
Phone (706) 854-8434

Other identifiers 1

IdentifierTypeStateIssuer
706-854-8434OtherPHONE NUMBER

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL info@therapytrailsga.com

National Provider Directory

National Provider Directory

Locations

536 Grand Slam Dr
Ste D
Evans, GA 30809
Phone (706) 842-3330

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1567641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567641600000",
    "number": "1124677919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "536 GRAND SLAM DR STE D",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308098045",
            "telephone_number": "706-854-8434",
            "fax_number": "706-854-8435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "536 GRAND SLAM DR STE D",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308098045",
            "telephone_number": "706-854-8434",
            "fax_number": "706-854-8435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERAPY TRAILS OF EVANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-05",
        "last_updated": "2019-09-05",
        "status": "A",
        "authorized_official_last_name": "PEAVY",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER/SLP",
        "authorized_official_telephone_number": "706-842-3330"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHONE NUMBER",
            "identifier": "706-854-8434",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "info@therapytrailsga.com",
            "affiliation": "N",
            "endpointDescription": "Practice Office Email",
            "address_1": "536 Grand Slam Dr Ste D",
            "city": "Evans",
            "state": "GA",
            "country_code": "US",
            "postal_code": "308098045",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Evans, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2019; 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.