NPIMap

Organization Active NPI

Neurosport Physical Therapy & Rehabilitation Specialist Inc.

  • Physical Therapist
  • Marietta, GA
National Provider Identifier
1376546341
Registry record updated Sep 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
003709 Issued in GA
Legal business name
NEUROSPORT PHYSICAL THERAPY & REHABILITATION SPECIALIST INC.
Practice address
1163 Johnson Ferry Rd
Ste 100
Marietta, GA 30068-2764
Phone
(770) 321-0155
Fax
(770) 321-8426
NPI assigned
May 24, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2014

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

Authorized official

Name
Miss Moriah Morgan
Title
Regional Office Manager
Phone
(770) 321-0155

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 003709 GA Primary

Addresses

Primary practice location

1163 Johnson Ferry Rd
Ste 100
Marietta, GA 30068-2764

Mailing address

1163 Johnson Ferry Rd
Ste 100
Marietta, GA 30068-2764
Phone (770) 321-0155

Other identifiers 4

IdentifierTypeStateIssuer
5093346OtherAETNA PPO, MC
606717OtherAETNA HMO
52266108OtherBCBS OF GEORGIA
650016944OtherGARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040426000244 GA Part B Supplier - Clinic/Group Practice 6608862420 Receives reassigned benefits from 1 practitioner
Practice locations: Woodstock, GA; Roswell, GA; Hiawassee, GA

National Provider Directory

National Provider Directory
Tax ID family
Neurosport Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3365 Piedmont Rd NE
Ste 1260
Atlanta, GA 30305
Phone (404) 504-9030

89 Hiawassee Park Dr
Hiawassee, GA 30546
Phone (470) 275-5015

1163 Johnson Ferry Rd
Ste 100
Marietta, GA 30068
Phone (770) 321-0155

625 W Crossville Rd
Ste 216
Roswell, GA 30075
Phone (470) 349-8884

12201 Highway 92
Ste C
Woodstock, GA 30188
Phone (470) 632-8335

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410825600000",
    "number": "1376546341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1163 JOHNSON FERRY RD",
            "address_2": "STE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300682764",
            "telephone_number": "770-321-0155",
            "fax_number": "770-321-8426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1163 JOHNSON FERRY RD",
            "address_2": "STE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300682764",
            "telephone_number": "770-321-0155",
            "fax_number": "770-321-8426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROSPORT PHYSICAL THERAPY & REHABILITATION SPECIALIST INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-24",
        "last_updated": "2014-09-16",
        "status": "A",
        "authorized_official_last_name": "MORGAN",
        "authorized_official_first_name": "MORIAH",
        "authorized_official_title_or_position": "REGIONAL OFFICE MANAGER",
        "authorized_official_telephone_number": "770-321-0155",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "003709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO, MC",
            "identifier": "5093346",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "606717",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF GEORGIA",
            "identifier": "52266108",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "650016944",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2014; 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.