NPIMap

Organization Active NPI

Crochet Physical Therapy LLC

  • Physical Therapist
  • Decatur, GA
National Provider Identifier
1558063388
Registry record updated Mar 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
CROCHET PHYSICAL THERAPY LLC
Practice address
1382 Scott Blvd Ste a
Decatur, GA 30030-1461
Phone
(404) 377-1223
NPI assigned
Mar 17, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2023

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

Authorized official

Name
Mr. David Carter
Title
Credentialing Manager
Phone
(859) 737-0904

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

1382 Scott Blvd Ste a
Decatur, GA 30030-1461

Mailing address

1382 Scott Blvd Ste a
Decatur, GA 30030-1461
Phone (404) 377-1223

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230417001964 GA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9638544083 Receives reassigned benefits from 4 practitioners
Practice locations: Decatur, GA

National Provider Directory

National Provider Directory

Locations

1382 Scott Blvd
Ste A
Decatur, GA 30030
Phone (404) 337-1223

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1679011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679011200000",
    "number": "1558063388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1382 SCOTT BLVD STE A",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300301461",
            "telephone_number": "404-377-1223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1382 SCOTT BLVD STE A",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300301461",
            "telephone_number": "404-377-1223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROCHET PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-17",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-17",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "859-737-0904",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2023; 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.