Individual provider Active NPI

Brittany Gibson

  • Physical Therapy Assistant
  • Roswell, GA
National Provider Identifier
1194414979
Registry record updated May 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PTA004128 Issued in GA
Practice address
11350 Woodstock Rd
Roswell, GA 30075-7541
Phone
(770) 645-2340
NPI assigned
May 5, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PTA004128 GA Primary

Addresses

Primary practice location

11350 Woodstock Rd
Roswell, GA 30075-7541

Mailing address

7880 Fox Crossing Rd
Laurinburg, NC 28352-6192

Other practice location 1

7880 Fox Crossing Rd
Laurinburg, NC 28352-6192
Phone (910) 280-8618

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

LicenseStateTypeSpecialty
PTA004128GAMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1683244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683244800000",
    "number": "1194414979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7880 FOX CROSSING RD",
            "city": "LAURINBURG",
            "state": "NC",
            "postal_code": "283526192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11350 WOODSTOCK RD",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300757541",
            "telephone_number": "770-645-2340"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7880 Fox Crossing Rd",
            "address_purpose": "LOCATION",
            "city": "Laurinburg",
            "state": "NC",
            "postal_code": "283526192",
            "country_code": "US",
            "telephone_number": "910-280-8618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "BRITTANY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-05",
        "last_updated": "2023-05-05",
        "certification_date": "2023-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA004128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 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.

Verify at the official NPI Registry.