Re Generate Physiotherapy, LLC

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

PT011852 Issued in GA

Legal business name

RE GENERATE PHYSIOTHERAPY, LLC

Practice address

1240 Ga-54
Building 700
Fayetteville, GA 30214

Phone

(678) 506-0196

Fax

(706) 611-0436

NPI assigned

May 31, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Jennifer McGowan, PT, DPT, OCS

Title

Business Owner/Physical Therapist

Phone

(678) 506-0196

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527724800000",
    "number": "1558853085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 ESSEX CIRCLE",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "30215",
            "telephone_number": "678-506-0196",
            "fax_number": "706-661-0436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 GA-54",
            "address_2": "BUILDING 700",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "30214",
            "telephone_number": "678-506-0196",
            "fax_number": "706-611-0436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RE GENERATE PHYSIOTHERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-31",
        "last_updated": "2018-05-31",
        "status": "A",
        "authorized_official_last_name": "MCGOWAN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "BUSINESS OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "678-506-0196",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT, OCS"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "GA",
            "license": "PT011852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2018; 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.