Active NPI
Brenna Jill Stallworth, PT
- Physical Therapist
- Kennesaw, GA
National Provider Identifier
1265003453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT009395
- Practice address
- 3114 Cobb Pkwy NW
Kennesaw, GA 30152-1017 - Phone
- (770) 377-2927
- NPI assigned
- Jul 8, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT009395 | GA | Primary |
Addresses
Primary practice location
3114 Cobb Pkwy NW
Kennesaw, GA 30152-1017
Mailing address
6168 Windflower Dr
Powder Springs, GA 30127-8321
Phone (770) 377-2927
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
| License | State | Type | Specialty |
|---|---|---|---|
| PT009395 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625702400000",
"number": "1265003453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6168 WINDFLOWER DR",
"city": "POWDER SPRINGS",
"state": "GA",
"postal_code": "301278321",
"telephone_number": "770-377-2927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3114 COBB PKWY NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301521017",
"telephone_number": "770-377-2927"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STALLWORTH",
"first_name": "BRENNA",
"middle_name": "JILL",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-08",
"last_updated": "2021-07-08",
"certification_date": "2021-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT009395",
"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 Jul 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.