NPIMap

Organization Active NPI

PT Solutions of Acworth LLC

  • Physical Therapist
  • Kennesaw, GA
National Provider Identifier
1184075210
Registry record updated Jun 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PT SOLUTIONS OF ACWORTH LLC
Practice address
1615 Ridenour Blvd NW
Suite 204
Kennesaw, GA 30152-4463
Phone
(770) 917-1395
Fax
(770) 423-3369
NPI assigned
Jun 30, 2016
Organization subpart
Yes
Parent organization
PT SOLUTIONS OF ACWORTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 30, 2016

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

Authorized official

Name
Ms. Jennifer L Hall
Title
Chief Financial Officer
Phone
(678) 478-3792

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

1615 Ridenour Blvd NW
Suite 204
Kennesaw, GA 30152-4463

Mailing address

1990 Vaughn Rd NW
Suite 330
Kennesaw, GA 30144-7098
Phone (770) 917-1395

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040629000794 GA Part B Supplier - Clinic/Group Practice 0042291817 Receives reassigned benefits from 14 practitioners
33 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hahira, GA; Watkinsville, GA; Villa Rica, GA; Valdosta, GA; Tyrone, GA; Norcross, GA; Evans, GA; Decatur, GA…

Other NPIs on the same Medicare enrollment 33

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 33

National Provider Directory

National Provider Directory
Part of
PT Solutions of Acworth LLC

Locations

1615 Ridenour Blvd NW
Ste 204
Kennesaw, GA 30152
Phone (770) 580-8070

1990 Vaughn Rd NW
Ste 330
Kennesaw, GA 30144
Phone (678) 403-3632

Practitioners & affiliated clinicians

Practitioners 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1467244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467244800000",
    "number": "1184075210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 VAUGHN RD NW",
            "address_2": "SUITE 330",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301447098",
            "telephone_number": "770-917-1395",
            "fax_number": "770-423-3369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 RIDENOUR BLVD NW",
            "address_2": "SUITE 204",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301524463",
            "telephone_number": "770-917-1395",
            "fax_number": "770-423-3369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PT SOLUTIONS OF ACWORTH LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PT SOLUTIONS OF ACWORTH",
        "enumeration_date": "2016-06-30",
        "last_updated": "2016-06-30",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "678-478-3792",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jun 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.