NPIMap

Organization Active NPI

Lake Dow Physical Therapy, Inc.

  • Physical Therapist
  • McDonough, GA
National Provider Identifier
1164690780
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT006775 Issued in GA
Legal business name
LAKE DOW PHYSICAL THERAPY, INC.
Practice address
42 Old Jackson Rd
McDonough, GA 30252-3029
Phone
(678) 583-6345
Fax
(678) 583-6346
NPI assigned
Feb 16, 2008
Last updated
Jun 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Dr. Kimberley M Jedding, DPT, CEASNPI 1285713537
Title
President
Phone
(678) 583-6345

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT006775 GA Primary

Addresses

Primary practice location

42 Old Jackson Rd
McDonough, GA 30252-3029

Mailing address

42 Old Jackson Rd
McDonough, GA 30252-3029
Phone (678) 583-6345

Other identifiers 1

IdentifierTypeStateIssuer
PT006775OtherGAPT LISCENSE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1203120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1164690780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 OLD JACKSON RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302523029",
            "telephone_number": "678-583-6345",
            "fax_number": "678-583-6346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 OLD JACKSON RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302523029",
            "telephone_number": "678-583-6345",
            "fax_number": "678-583-6346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE DOW PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-16",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "JEDDING",
        "authorized_official_first_name": "KIMBERLEY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-583-6345",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT, CEAS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT006775",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LISCENSE",
            "identifier": "PT006775",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McDonough, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.