Professional Rehabilitation Associates, LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT001102 Issued in GA

Legal business name

PROFESSIONAL REHABILITATION ASSOCIATES, LLC

Doing business as

Able Rehab of PRA, LLC

Practice address

2000 Mirror Lake Blvd Ste T
Villa Rica, GA 30180-2126

Phone

(770) 783-9797

NPI assigned

Dec 9, 2013

Last updated

May 29, 2014By 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

Mrs. Colleen Goodwin, OTNPI 1396709051

Title

Owner

Phone

(770) 783-9797

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Able Rehab of PRA, LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 3

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.

• Colleen A. Goodwin, OT

  • Occupational Therapist
  • Douglasville, GA
  • NPI 1396709051
  Medicare reassignment NPD Authorized official
• Brooke Cuff Burguillos

  • Speech-Language Pathologist
  • Villa Rica, GA
  • NPI 1376266569
  NPD (past)
• Carlie Sandefur Fratt, M.ED CCC-SLP

  • Speech-Language Pathologist
  • Villa Rica, GA
  • NPI 1598470072
  NPD (past)

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

{
    "created_epoch": "1386547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401321600000",
    "number": "1528499043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 MIRROR LAKE BLVD STE T",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301802126",
            "telephone_number": "770-783-9797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 MIRROR LAKE BLVD STE T",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301802126",
            "telephone_number": "770-783-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL REHABILITATION ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-09",
        "last_updated": "2014-05-29",
        "status": "A",
        "authorized_official_last_name": "GOODWIN",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-783-9797",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OT"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "OT001102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE UNSPECIFIED",
            "identifier": "67BBBGV",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Able Rehab of PRA, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Macy Preston
• Jerry Price Jr., CRNA
• Lawrence W Price, MD
• Virginia H Price, MD
• Pristine Healthcare
• Progressive Care Services Inc.
• Providence Immediate Care Incorporated
• PT Solutions of Acworth, LLC
• Publix Super Markets Inc (Publix Pharmacy #2011)
• Susan Pullen, RN

• Occupational Therapist in Villa Rica, GA
• Providers in Villa Rica, GA by specialty
• Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2014; 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.