NPIMap

Organization Active NPI

Orthosport Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Kennesaw, GA
National Provider Identifier
1174501100
Registry record updated Feb 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
3909 Issued in GA
Legal business name
ORTHOSPORT PHYSICAL THERAPY LLC
Practice address
3450 Acworth Due West Rd NW
Suite 310
Kennesaw, GA 30144
Phone
(770) 974-7494
Fax
(770) 974-9141
NPI assigned
Jan 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2008

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

Authorized official

Name
Mrs. Kim E. Chastain, P.T.NPI 1639231103
Title
Founder and Ceo
Phone
(770) 974-7494

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 Therapy Clinic/Center 261QP2000X 3909 GA Primary

Addresses

Primary practice location

3450 Acworth Due West Rd NW
Suite 310
Kennesaw, GA 30144

Mailing address

3450 Acworth Due West Rd NW
Suite 310
Kennesaw, GA 30144-1001
Phone (770) 974-7494

Other identifiers 1

IdentifierTypeStateIssuer
393730OtherGABLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

3450 Acworth Due West Rd NW
Ste 310
Kennesaw, GA 30144
Phone (770) 974-7494

1200 Cobb Pkwy N
Marietta, GA 30062
Phone (770) 975-1139

209 Towne Lake Pkwy
Woodstock, GA 30188
Phone (678) 640-4606

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202342400000",
    "number": "1174501100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 ACWORTH DUE WEST RD NW",
            "address_2": "SUITE 310",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301441001",
            "telephone_number": "770-974-7494",
            "fax_number": "770-974-9141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 ACWORTH DUE WEST RD NW",
            "address_2": "SUITE 310",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "30144",
            "telephone_number": "770-974-7494",
            "fax_number": "770-974-9141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOSPORT PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-09",
        "last_updated": "2008-02-07",
        "status": "A",
        "authorized_official_last_name": "CHASTAIN",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "FOUNDER AND CEO",
        "authorized_official_telephone_number": "770-974-7494",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "GA",
            "license": "3909",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "393730",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennesaw, GA

Sources for this page

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