Individual provider Active NPI

Mariah Brianna Gamble, PT, DPT

  • Physical Therapist
  • Peachtree City, GA
National Provider Identifier
1417559170
Registry record updated Nov 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT015049 Issued in GA
Practice address
1280 Highway 74 S Ste 210
Peachtree City, GA 30269-3077
Phone
(770) 486-6398
Fax
(770) 486-6399
NPI assigned
Nov 9, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2020

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 PT015049 GA Primary

Addresses

Primary practice location

1280 Highway 74 S Ste 210
Peachtree City, GA 30269-3077

Mailing address

1200 Corporate Dr Ste 400
Hoover, AL 35242-5424
Phone (423) 238-7217

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210302001633 GA Practitioner - Physical Therapist in Private Practice 7810303690 Reassigns benefits to 5 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT015049GAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Independent Physical Therapy of Georgia, LLC Physical Therapist Current Accepting new patients
Independent Physical Therapy of Georgia, LLC Physical Therapist CurrentSince Nov 30, 2020 Accepting new patients
Emory Physical Therapy, LLC CurrentSince Jan 18, 2022 Accepting new patients
Fox Rehabilitation Ga, LLC Physical Therapist CurrentSince Jul 1, 2023 Accepting new patients
Benchmark Physical Therapy, Inc CurrentSince Nov 30, 2020 Accepting new patients
Emory Physical Therapy, LLC Current Accepting new patients
Independent Physical Therapy of Ga, LLC Physical Therapist CurrentSince Nov 30, 2020 Accepting new patients
Benchmark Physical Therapy, Inc Physical Therapist CurrentSince Nov 30, 2020 Accepting new patients
Emory Physical Therapy, LLC CurrentSince Jan 18, 2022 Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

21 Ortho Ln
Atlanta, GA 30329
Phone (404) 778-2516

1025 E West Connector
Ste 406
Austell, GA 30106
Phone (770) 384-1001

1845 Satellite Blvd
Ste 750
Duluth, GA 30097
Phone (404) 778-6490

7130 Mount Zion Blvd
Ste 9
Jonesboro, GA 30236
Phone (770) 603-5660

1280 Highway 74 S
Ste 210
Peachtree City, GA 30269
Phone (770) 486-6398

277 Highway 74 N
Ste 203
Peachtree City, GA 30269
Phone (678) 364-0337

Organizations & group practices 10

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": "1604880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604880000000",
    "number": "1417559170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CORPORATE DR STE 400",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352425424",
            "telephone_number": "423-238-7217",
            "fax_number": "423-238-3473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1280 HIGHWAY 74 S STE 210",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302693077",
            "telephone_number": "770-486-6398",
            "fax_number": "770-486-6399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBLE",
        "first_name": "MARIAH",
        "middle_name": "BRIANNA",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-09",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT015049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peachtree City, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.