NPIMap

Organization Active NPI

West Cobb Physical Therapy

  • Physical Therapist
  • Powder Springs, GA
National Provider Identifier
1417048885
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT007058 Issued in GA
Legal business name
WEST COBB PHYSICAL THERAPY
Practice address
5041 Dallas Hwy Ste C
Building 1 Suite C
Powder Springs, GA 30127-6458
Phone
(770) 425-2151
Fax
(770) 425-5982
NPI assigned
Sep 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Richard Darin Durell, PTNPI 1255529483
Title
Directore
Phone
(770) 425-2151

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT007058 GA Primary

Addresses

Primary practice location

5041 Dallas Hwy Ste C
Building 1 Suite C
Powder Springs, GA 30127-6458

Mailing address

5041 Dallas Hwy Ste C
Building 1 Suite C
Powder Springs, GA 30127-6458
Phone (770) 425-2151

Other names 1

  • Venture Physical Therapy West Cobb Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031106000684 GA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5395658363 Receives reassigned benefits from 1 practitioner
Practice locations: Powder Springs, GA

National Provider Directory

National Provider Directory

Locations

5041 Dallas Hwy
Bldg 1C
Powder Springs, GA 30127
Phone (770) 425-2151

5041 Dallas Hwy
Bldg 100
Powder Springs, GA 30127
Phone (770) 425-2152

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417048885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5041 DALLAS HWY STE C",
            "address_2": "BUILDING 1 SUITE C",
            "city": "POWDER SPRINGS",
            "state": "GA",
            "postal_code": "301276458",
            "telephone_number": "770-425-2151",
            "fax_number": "770-425-5982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5041 DALLAS HWY STE C",
            "address_2": "BUILDING 1 SUITE C",
            "city": "POWDER SPRINGS",
            "state": "GA",
            "postal_code": "301276458",
            "telephone_number": "770-425-2151",
            "fax_number": "770-425-5982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST COBB PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DURELL",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "DARIN",
        "authorized_official_title_or_position": "DIRECTORE",
        "authorized_official_telephone_number": "770-425-2151",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT007058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Venture Physical Therapy West Cobb",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Powder Springs, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.