Individual provider Active NPI

Olivia Mould

  • Physical Therapist
  • Kennesaw, GA
National Provider Identifier
1417637414
Registry record updated Jul 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
600 Chastain Rd NW Ste 428
Kennesaw, GA 30144-3210
Phone
(770) 425-6701
NPI assigned
Jul 24, 2023
Last updated
Jul 24, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2023

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 NU Primary

Addresses

Primary practice location

600 Chastain Rd NW Ste 428
Kennesaw, GA 30144-3210

Mailing address

1200 Corporate Dr Ste 400
Hoover, AL 35242-5424

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231017000233 GA Practitioner - Physical Therapist in Private Practice 9931554540 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

600 Chastain Rd NW
Suite 428
Kennesaw, GA 30144-3210
Phone (770) 425-6701

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Benchmark Physical Therapy, Inc CurrentSince Jul 31, 2023 Accepting new patients
Independent Physical Therapy of Georgia, LLC Physical Therapist CurrentSince Jul 31, 2023 Accepting new patients
Benchmark Physical Therapy Inc Physical Therapist CurrentSince Jul 31, 2023 Accepting new patients
Independent Physical Therapy of Georgia, LLC Physical Therapist CurrentSince Jul 31, 2023 Accepting new patients

Locations

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

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

1370 Buford Hwy
Ste 108
Cumming, GA 30041
Phone (770) 205-1669

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

4200 Wade Green Rd NW
Ste 140
Kennesaw, GA 30144
Phone (770) 627-2364

600 Chastain Rd NW
Ste 428
Kennesaw, GA 30144
Phone (770) 425-6701

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1690156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1417637414",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 CHASTAIN RD NW STE 428",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301443210",
            "telephone_number": "770-425-6701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOULD",
        "first_name": "OLIVIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-24",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennesaw, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.