Evan Blackburn, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT005107 Issued in GA

Practice address

1180 Satellite Blvd NW
Suite 100
Suwanee, GA 30024-4636

Phone

(404) 367-2080

Fax

(770) 495-3493

NPI assigned

Aug 23, 2006

Last updated

Nov 22, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Cleveland University of Medicine and Surgery - NLG, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Athletes in Motion LLCGroup PAC ID 7618402090, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Athletes in Motion LLC

  • Physical Therapy Clinic/Center
  • Suwanee, GA
  • NPI 1780430306
  Medicare reassignment Care Compare group NPD
• Advance Rehabilitation & Consulting Limited Partnership

  • Physical Therapist
  • Saint Marys, GA
  • NPI 1235434283
  Medicare reassignment NPD
• Advance Rehabilitation & Consulting Limited Partnership

  • Durable Medical Equipment & Medical Supplies
  • Jasper, GA
  • NPI 1164115671

  Physical Therapist

  NPD
• High Performance Physical Therapy Centers

  dba Atlanta Falcons Physical Therapy Centers

  • Physical Therapist
  • Suwanee, GA
  • NPI 1467645689
  NPD (past)

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385078400000",
    "number": "1154437754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 SATELLITE BLVD NW",
            "address_2": "SUITE 100",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244636",
            "telephone_number": "404-367-2080",
            "fax_number": "770-495-3493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 SATELLITE BLVD NW",
            "address_2": "SUITE 100",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244636",
            "telephone_number": "404-367-2080",
            "fax_number": "770-495-3493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "EVAN",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2013-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT005107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joanne Bien-Aime, RBT
• Billy Adams, LPC, LLC
• Ellen Biros, M.S., L.C.S.W.
• Brantley Black Bruce, CCC-SLP
• Lisa Black
• Brittany Bledsoe, PHARM D.
• Blossom Pediatric Dentistry, LLC
• Blpodiatry LLC
• Emily Blum, DC
• Emily Rose Bolt, MS, BCBA

• Physical Therapist in Suwanee, GA
• Providers in Suwanee, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.