Vital Village Physical Therapy

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

VITAL VILLAGE PHYSICAL THERAPY

Practice address

116 Love LN
Woodstock, GA 30188-4281

Phone

(706) 994-2852

NPI assigned

Sep 20, 2023

Last updated

Sep 20, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shaun UnderwoodNPI 1356129415

Title

Owner

Phone

(706) 994-2852

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

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.

• Shaun Underwood

  • Physical Therapist
  • Woodstock, GA
  • NPI 1356129415
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1695168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695168000000",
    "number": "1255119319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 LOVE LN",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301884281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 LOVE LN",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301884281",
            "telephone_number": "706-994-2852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL VILLAGE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-20",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A",
        "authorized_official_last_name": "UNDERWOOD",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-994-2852"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miya Villagrana, RBT
• Alexa Isabel Vinasco
• Camie L. Vincent, LPC, LMHC
• Vineyard Hospice
• Virtis Health, LLC (Soleo Health)
• Voices & Motion Inc
• Voices and Motion, Inc
• Amanda Naseef Volker, NP
• W Bruce Fink DDS PC
• Rhonda Rouse Wachsmuth, M.D.

• Physical Therapist in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; 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.