Kingdom Physical Therapy and Wellness LLC
Organization Active NPI Physical Therapy Clinic/Center · Fort Valley, GA
NPI 1144110396 · NPPES record last updated Jul 21, 2025
Key facts
- NPI
- 1144110396
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapy Clinic/Center 261QP2000X
- Legal business name
- KINGDOM PHYSICAL THERAPY AND WELLNESS LLC
- Practice address
- 1410 Gassett Road N
Fort Valley, GA 31030 - Phone
- (478) 955-6956
- NPI assigned
- Jul 8, 2025
- Organization subpart
- No
Authorized official
- Name
- Dr. Seth Johnson, DPT
- Title
- Owner
- Phone
- (478) 955-6956
Practitioners 1
-
Seth Johnson, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250829001064 | GA | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 6800397944 |
Receives reassigned benefits from 1 practitioner Practice locations: Fort Valley, GA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | Yes |
Addresses
Primary practice location
1410 Gassett Road N
Fort Valley, GA 31030
Mailing address
1410 Gassett Road N
Fort Valley, GA 31030
Phone (478) 955-6956
Other providers in Fort Valley, GA
- Janette Johnson
- Seth Johnson
- Tamikica Levette Johnson
- Ravikanth R Kallu
- Keyanna Professional Services, LTD Company
- Druscilla Lockett
- Janet Kay Logan
- Macon Occupational Medicine
- Chatity M Mallard
- Ulysses Luther Marable III
All providers in Fort Valley, GA · Physical Therapy Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.