Individual provider Active NPI

Samuel Lee Echols, PT

  • Physical Therapist
  • Rome, GA
National Provider Identifier
1396741583
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT004801 Issued in GA
Practice address
519 Broad St Ste 300
Rome, GA 30161-1736
Phone
(706) 346-6035
NPI assigned
Jun 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT004801 GA Primary

Addresses

Primary practice location

519 Broad St Ste 300
Rome, GA 30161-1736

Mailing address

PO Box 1975
Rome, GA 30162-1975
Phone (706) 346-6035

Other identifiers 3

IdentifierTypeStateIssuer
000802645T,R,U,V,W,XMedicaidGA
000802645C,E,L,M,N,PMedicaidGA
P00319887OtherGARR MEDICARE

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT004801GAMDPhysical Therapist
004801GAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sixfourthree OT, LLC CurrentSince Mar 1, 2025 Accepting new patients
Putnam Physical Therapy Services, LLC Physical Therapist Current Accepting new patients
Southeastern Physical Therapy, LLC Physical Therapist PastSince Feb 1, 2021 Accepting new patients
Low Country Physical Therapy Physical Therapist PastSince Jun 5, 2024 Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1396741583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1975",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301621975",
            "telephone_number": "706-346-6035",
            "fax_number": "866-858-7371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 BROAD ST STE 300",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301611736",
            "telephone_number": "706-346-6035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ECHOLS",
        "first_name": "SAMUEL",
        "middle_name": "LEE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT004801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000802645T,R,U,V,W,X",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000802645C,E,L,M,N,P",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00319887",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rome, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; 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.