Active NPI
Gina Maria Hartigan
- Physical Therapy Assistant
- Ideal, GA
National Provider Identifier
1164098455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA004980
- Practice address
- 201 Poplar St
Ideal, GA 31041-6264 - Phone
- (478) 949-2270
- NPI assigned
- May 27, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA25874 | FL | |
| Physical Therapy Assistant | 225200000X | PTA004980 | GA | Primary |
Addresses
Primary practice location
201 Poplar St
Ideal, GA 31041-6264
Mailing address
2212 Blue Lake Dr
Pensacola, FL 32506-6068
Phone (850) 418-2588
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 |
|---|---|---|---|
| PTA25874 | FL | MD | Physical Therapy Assistant |
| PTA004980 | GA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622073600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694390400000",
"number": "1164098455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2212 BLUE LAKE DR",
"city": "PENSACOLA",
"state": "FL",
"postal_code": "325066068",
"telephone_number": "850-418-2588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 POPLAR ST",
"city": "IDEAL",
"state": "GA",
"postal_code": "310416264",
"telephone_number": "478-949-2270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARTIGAN",
"first_name": "GINA",
"middle_name": "MARIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-27",
"last_updated": "2023-09-11",
"certification_date": "2023-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "PTA25874",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "GA",
"license": "PTA004980",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ideal, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.