Individual provider Active NPI

Shyrece Celestine

  • Physical Therapist
  • Roswell, GA
National Provider Identifier
1487364428
Registry record updated Nov 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT016137 Issued in GA
Practice address
75 Magnolia St
Roswell, GA 30075-4381
Phone
(337) 274-6953
NPI assigned
Nov 30, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2022

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 PT016137 GA Primary

Addresses

Primary practice location

75 Magnolia St
Roswell, GA 30075-4381

Mailing address

3631 Chamblee Tucker Rd Unit 941084
Atlanta, GA 31141-5005
Phone (337) 274-6953

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
PT016137GAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Healthcare Services, Inc. Physical Therapist CurrentSince Mar 1, 2023 Accepting new patients
Legacy Healthcare Services, Inc. Physical Therapist CurrentSince Mar 1, 2023 Accepting new patients
Legacy Healthcare Services Inc Physical Therapist CurrentSince Mar 1, 2023 Accepting new patients

Locations

3333 E Cherokee Dr
Canton, GA 30115
Phone (470) 714-6698

110 Horizon Dr
Ste 310
Raleigh, NC 27615
Phone (970) 215-3300

Organizations & group practices 3

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": "1669766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669766400000",
    "number": "1487364428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3631 CHAMBLEE TUCKER RD UNIT 941084",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311415005",
            "telephone_number": "337-274-6953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 MAGNOLIA ST",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300754381",
            "telephone_number": "337-274-6953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CELESTINE",
        "first_name": "SHYRECE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-30",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT016137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2022; 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.