Individual provider Active NPI

Ethan Barrett, PT, DPT

  • Physical Therapist
  • Gainesville, GA
National Provider Identifier
1164035648
Registry record updated Oct 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT014917 Issued in GA
Practice address
1640 Jesse Jewell Pkwy NE
Gainesville, GA 30501-2561
Phone
(770) 536-9300
Fax
(770) 536-9389
NPI assigned
Aug 25, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT014917 GA Primary

Addresses

Primary practice location

1640 Jesse Jewell Pkwy NE
Gainesville, GA 30501-2561

Mailing address

2400 Wisteria Dr Ste a
Snellville, GA 30078-2689
Phone (770) 982-0102

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200916003245 GA Practitioner - Physical Therapist in Private Practice 8224456603 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atlanta Rehabilitation and Performance CenterGroup PAC ID 5890692917, 95 clinicians

Practice addresses (Care Compare)

1640 Jesse Jewell Pkwy SE
Suite 1a
Gainesville, GA 30501-2547
Phone (770) 536-9300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Atlanta Rehabilitation and Performance Center CurrentSince Aug 24, 2020 Accepting new patients
Atlanta Rehabilitation and Performance Center CurrentSince Aug 24, 2020 Accepting new patients
Atlanta Rehabilitation and Performance Center CurrentSince Aug 29, 2021 Accepting new patients

Locations

1640 Jesse Jewell Pkwy NE
Gainesville, GA 30501
Phone (770) 536-9300

4220 Mundy Mill Pl
Ste 2B
Oakwood, GA 30566
Phone (678) 450-9933

2400 Wisteria Dr
Ste A
Snellville, GA 30078
Phone (770) 982-0102

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1598313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633564800000",
    "number": "1164035648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 WISTERIA DR STE A",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300782689",
            "telephone_number": "770-982-0102",
            "fax_number": "770-982-0130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 JESSE JEWELL PKWY NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305012561",
            "telephone_number": "770-536-9300",
            "fax_number": "770-536-9389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARRETT",
        "first_name": "ETHAN",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-25",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT014917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; 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.