Trident Physical Therapy, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

TRIDENT PHYSICAL THERAPY, LLC

Practice address

248 E Crogan St Ste 5
Lawrenceville, GA 30046-5069

Phone

(770) 910-7227

NPI assigned

Sep 22, 2021

Last updated

Jul 14, 2022By 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

Kimberly Stanford, DPTNPI 1568096014

Title

Owner

Phone

(770) 910-7227

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 4

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.

• Kimberly Stanford, PT, DPT, OCS

  • Physical Therapist
  • Lawrenceville, GA
  • NPI 1568096014
  Medicare reassignment Care Compare group NPD Authorized official
• Claire Marie Yurko, DPT

  • Physical Therapist
  • Marietta, GA
  • NPI 1104257179
  Medicare reassignment Care Compare group NPD
• Ikraan M Sheekh Nuur, PT, DPT

  • Physical Therapist
  • Atlanta, GA
  • NPI 1891503124
  Medicare reassignment Care Compare group
• Hannah Sandstrom

  • Physical Therapist
  • Tucker, GA
  • NPI 1356270425
  NPD

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

{
    "created_epoch": "1632268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657756800000",
    "number": "1275204943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "248 E CROGAN ST STE 5",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300465069",
            "telephone_number": "770-910-7227",
            "fax_number": "470-221-1514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "248 E CROGAN ST STE 5",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300465069",
            "telephone_number": "770-910-7227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIDENT PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-22",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A",
        "authorized_official_last_name": "STANFORD",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-910-7227",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judy Trang-Mangonon, MD
• Kathy C Trawick, MD
• Susan Traynum Harry, RN
• Maritsa Genesta Tremouliaris
• Richard William Trent, MD
• Trinity Therapeutic Touch LLC
• Rachel Megan Tripp
• Triumph Health Services LLC
• Akash Ashwin Trivedi, M.D.
• Olivia Trocano

• Physical Therapy Clinic/Center in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Physical Therapy Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2022; 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.