Jordan David Galentine, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA003970 Issued in GA

Practice address

4754 Martin Rd Ste 200
Flowery Branch, GA 30542-3507

Phone

(770) 967-4377

Fax

(770) 967-8077

NPI assigned

Apr 23, 2018

Last updated

Apr 23, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Back in the Game Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Flowery Branch, GA
  • NPI 1962669275
  NPD (past)
• Northeast Georgia Rehabilitation Center,Inc

  • Physical Therapy Clinic/Center
  • Royston, GA
  • NPI 1821008087
  NPD (past)

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

{
    "created_epoch": "1524441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524441600000",
    "number": "1255828554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4754 MARTIN RD STE 200",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305423507",
            "telephone_number": "770-967-4377",
            "fax_number": "770-967-8077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4754 MARTIN RD STE 200",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305423507",
            "telephone_number": "770-967-4377",
            "fax_number": "770-967-8077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2300 Liam Ave Ste 103",
            "address_purpose": "LOCATION",
            "city": "Dacula",
            "state": "GA",
            "postal_code": "300192265",
            "country_code": "US",
            "telephone_number": "470-294-0052",
            "fax_number": "470-294-0053",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GALENTINE",
        "first_name": "JORDAN",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-23",
        "last_updated": "2018-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA003970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisbeth A Fabiny, NBC-HWC
• Elizabeth Schneider Felton, PH.D, LPC
• Royal Edward Fink Jr., DDS
• Robert Wilton Fletcher III
• Shaakira A Ford, LCSW
• Luis Garcia, CRNA
• Genesis Family Medicine & Aesthetics, LLC
• Georgia CVS Pharmacy L.L.C. (CVS Pharmacy #05995)
• Georgia CVS Pharmacy LLC (CVS Pharmacy #17450)
• Georgia CVS Pharmacy, L.L.C. (CVS Pharmacy # 00792)

• Physical Therapy Assistant in Flowery Branch, GA
• Providers in Flowery Branch, GA by specialty
• Physical Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2018; 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.