Center for Physical Rehabilitation, Inc.

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

CENTER FOR PHYSICAL REHABILITATION, INC.

Practice address

3537 N Crossing Cir
Valdosta, GA 31602

Phone

(229) 333-0095

Fax

(229) 333-0756

NPI assigned

Sep 5, 2006

Last updated

Aug 2, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Revajo S. Broadwater, DPTNPI 1023111317

Title

President

Phone

(229) 333-0095

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Revajo S. Broadwater, PT

  • Physical Therapist
  • Valdosta, GA
  • NPI 1023111317
  Medicare reassignment NPD Authorized official
• Cathy J. Durland, PT

  • Physical Therapist
  • Albany, GA
  • NPI 1093808487
  NPD (past)
• Eric G. Sutherland, PT, COMT

  • Physical Therapist
  • Valdosta, GA
  • NPI 1639262025
  NPD (past)
• Emily M. Wade, PT

  • Physical Therapist
  • Valdosta, GA
  • NPI 1457444846
  NPD (past)
• James C. Pearce Jr., PTA

  • Physical Therapy Assistant
  • Pensacola, FL
  • NPI 1326439381
  NPD (past)

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186012800000",
    "number": "1497858781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3537 NORTH CROSSING CIRCLE",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "31602",
            "telephone_number": "229-333-0095",
            "fax_number": "229-333-0756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3537 N CROSSING CIR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "31602",
            "telephone_number": "229-333-0095",
            "fax_number": "229-333-0756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR PHYSICAL REHABILITATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-05",
        "last_updated": "2007-08-02",
        "status": "A",
        "authorized_official_last_name": "BROADWATER",
        "authorized_official_first_name": "REVAJO",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "229-333-0095",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Physical Therapy Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2007; 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.