Individual provider Active NPI

Colleen Maria O'Donnell

  • Physical Therapist
  • Tucker, GA
National Provider Identifier
1174291603
Registry record updated Nov 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT016863 Issued in GA
Practice address
5844 Lawrenceville Hwy
Tucker, GA 30084-1930
Phone
(770) 585-1151
NPI assigned
Aug 31, 2021
Last updated
Nov 20, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2025

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 PT016863 GA Primary

Addresses

Primary practice location

5844 Lawrenceville Hwy
Tucker, GA 30084-1930

Mailing address

6126 Ogeechee Rd
Mableton, GA 30126-2509
Phone (207) 877-4825

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251231003595 GA Practitioner - Physical Therapist in Private Practice 4183110869 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2222 Sullivan TRL
Easton, PA 18040-7958

6126 Ogeechee Rd
Mableton, GA 30126-2509

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT016863GAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
The Weston Group Inc. Physical Therapist CurrentSince Dec 4, 2025 Accepting new patients
The Weston Group Inc. Physical Therapist CurrentSince Dec 4, 2025 Accepting new patients
Reliant Senior Living LLC Physical Therapist CurrentSince Nov 17, 2025 Accepting new patients
Reliant Senior Living LLC Physical Therapist CurrentSince Nov 17, 2025 Accepting new patients

Locations

1100 Reinhardt College Pkwy
Canton, GA 30114
Phone (770) 721-2812

4838 S Cobb Dr SE
Smyrna, GA 30080
Phone (678) 210-7135

5800 Granite Pkwy
Ste 325
Plano, TX 75024

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1630368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763596800000",
    "number": "1174291603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6126 OGEECHEE RD",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301262509",
            "telephone_number": "207-877-4825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5844 LAWRENCEVILLE HWY",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300841930",
            "telephone_number": "770-585-1151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'DONNELL",
        "first_name": "COLLEEN",
        "middle_name": "MARIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-31",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT016863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucker, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2025; 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.