NPIMap

Organization Active NPI

Reid Clinic Sports Physical Therapy and Spine LLC

  • Physical Therapy Clinic/Center
  • Roswell, GA
National Provider Identifier
1609106418
Registry record updated Oct 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT009889 Issued in GA
Legal business name
REID CLINIC SPORTS PHYSICAL THERAPY AND SPINE LLC
Practice address
11660 Alpharetta Hwy Ste 560
Roswell, GA 30076-3883
Phone
(678) 667-3435
Fax
(404) 201-2080
NPI assigned
Dec 30, 2009
Last updated
Oct 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2024

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

Authorized official

Name
Mr. Reid Thomas Kelley, PTNPI 1336171974
Title
President
Phone
(678) 667-3435

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PT009889 GA Primary

Addresses

Primary practice location

11660 Alpharetta Hwy Ste 560
Roswell, GA 30076-3883

Mailing address

11660 Alpharetta Hwy
Ste 560
Roswell, GA 30076-3883
Phone (678) 667-3435

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101202000812 GA Part B Supplier - Clinic/Group Practice 5294921284 Receives reassigned benefits from 1 practitioner
Practice locations: Roswell, GA

National Provider Directory

National Provider Directory

Locations

1250 Upper Hembree Rd
Ste A
Roswell, GA 30076
Phone (678) 667-3435

1250 Upper Hembree Rd
Ste D
Roswell, GA 30076
Phone (770) 360-0044

Practitioners & affiliated clinicians

Practitioners 45

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 45

NPI Registry JSON

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

{
    "created_epoch": "1262131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729468800000",
    "number": "1609106418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11660 ALPHARETTA HWY",
            "address_2": "STE 560",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300763883",
            "telephone_number": "678-667-3435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11660 ALPHARETTA HWY STE 560",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300763883",
            "telephone_number": "678-667-3435",
            "fax_number": "404-201-2080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REID CLINIC SPORTS PHYSICAL THERAPY AND SPINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-30",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "REID",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-667-3435",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "GA",
            "license": "PT009889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; 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.