Active NPI
Rodney T Gibson, PT, PED.
- Physical Therapist
- Statesboro, GA
National Provider Identifier
1487748331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT002269
- Practice address
- 146 Northside Dr E
Statesboro, GA 30458-1096 - Phone
- (912) 764-4141
- Fax
- (912) 764-2247
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT002269 | GA | Primary |
Addresses
Primary practice location
146 Northside Dr E
Statesboro, GA 30458-1096
Mailing address
146 Northside Dr E
Statesboro, GA 30458-1096
Phone (912) 764-4141
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000879623A | Medicaid | GA | |
| 58-1838574 | Other | GA | TAX PROVIDER NUMBER |
| ACS157060500 | Other | GA | OWCP PROVIDER NUMBER |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cotton Ridge Physical Therapy LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Statesboro, GA
- NPI 1013956531
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319155200000",
"number": "1487748331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "146 NORTHSIDE DR E",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304581096",
"telephone_number": "912-764-4141",
"fax_number": "912-764-2247"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "146 NORTHSIDE DR E",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304581096",
"telephone_number": "912-764-4141",
"fax_number": "912-764-2247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "RODNEY",
"middle_name": "T",
"name_prefix": "Mr.",
"credential": "PT, PED.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2011-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT002269",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000879623A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX PROVIDER NUMBER",
"identifier": "58-1838574",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OWCP PROVIDER NUMBER",
"identifier": "ACS157060500",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Statesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.