NPIMap

Organization Active NPI

Ducktails Pediatric Therapy and Wellness Inc

  • Physical Therapy Clinic/Center
  • Evans, GA
National Provider Identifier
1558477695
Registry record updated Jun 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
DUCKTAILS PEDIATRIC THERAPY AND WELLNESS INC
Practice address
568 Blue Ridge Dr
Evans, GA 30809-3604
Phone
(706) 364-5262
Fax
(706) 364-5263
NPI assigned
Aug 22, 2006
Last updated
Jun 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2025

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

Authorized official

Name
Amy RossNPI 1972896058
Title
Owner / Otrl
Phone
(706) 364-5262

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X 003593 GA
Physical Therapy Clinic/Center 261QP2000X PT004118 GA
Physical Therapy Clinic/Center 261QP2000X PT008564 GA
Physical Therapy Clinic/Center 261QP2000X PT004423 GA
Physical Therapy Clinic/Center 261QP2000X NU Primary

Addresses

Primary practice location

568 Blue Ridge Dr
Evans, GA 30809-3604

Mailing address

568 Blue Ridge Dr
Evans, GA 30809-3604
Phone (706) 364-5262

Other practice location 1

421 Edgefield Rd Rm B117-5
Belvedere, SC 29841-2472
Phone (706) 364-5262

Other identifiers 2

IdentifierTypeStateIssuer
000767456CMedicaidGA
000717274CMedicaidGA

National Provider Directory

National Provider Directory

Locations

568 Blue Ridge Dr
Evans, GA 30809
Phone (706) 364-5262

103 Maple Dr
Ste 8
Martinez, GA 30907
Phone (706) 364-5262

421 Edgefield Rd
Rm B1175
Belvedere, SC 29841
Phone (706) 364-5262

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750204800000",
    "number": "1558477695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "568 BLUE RIDGE DR",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093604",
            "telephone_number": "706-364-5262",
            "fax_number": "706-364-5263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "568 BLUE RIDGE DR",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093604",
            "telephone_number": "706-364-5262",
            "fax_number": "706-364-5263"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "421 Edgefield Rd Rm B117-5",
            "address_purpose": "LOCATION",
            "city": "Belvedere",
            "state": "SC",
            "postal_code": "298412472",
            "country_code": "US",
            "telephone_number": "706-364-5262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DUCKTAILS PEDIATRIC THERAPY AND WELLNESS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "OWNER / OTRL",
        "authorized_official_telephone_number": "706-364-5262"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "GA",
            "license": "003593",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "GA",
            "license": "PT004118",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "GA",
            "license": "PT008564",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "GA",
            "license": "PT004423",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000767456C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000717274C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evans, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2025; 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.