Mohammad Reza Hesam, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT012700 Issued in GA

Practice address

4260 Peachtree Rd NE
Suite 200a
Atlanta, GA 30319-3782

Phone

(404) 400-6242

NPI assigned

Dec 7, 2016

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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)

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 to Action Sports Rehab, LLC.

  dba Georgia Sports Physical Therapy

  • Physical Therapist
  • Atlanta, GA
  • NPI 1477987568
  NPD (past)

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

{
    "created_epoch": "1481068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1326582578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4260 PEACHTREE RD NE",
            "address_2": "SUITE 200A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303193782",
            "telephone_number": "404-400-6242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4260 PEACHTREE RD NE",
            "address_2": "SUITE 200A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303193782",
            "telephone_number": "404-400-6242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "754 Peachtree St. NE",
            "address_2": "Suite 105",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "30308",
            "country_code": "US",
            "telephone_number": "404-381-8697",
            "fax_number": "404-962-6873",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HESAM",
        "first_name": "MOHAMMAD",
        "middle_name": "REZA",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-12-07",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT012700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph R Herzberger, PA
• Kathleen Lynn Herzer, LMSW
• David Warren Herzig, MD
• Alexander Maddox Herzog, MD
• Lonnie Herzog, M.D.
• Carole J. Hess, NPC
• Elisabeth M Hesse, MD
• Andrea Hessig
• Michelle Hession, LCSW
• Dallas Dan Von Hessler, D.O.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.