Active NPI
Barbara Wilson, PTA
- Physical Therapy Assistant
- Decatur, GA
National Provider Identifier
1609586213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA004964
- Practice address
- 1456 Church St
Decatur, GA 30030-1526 - Phone
- (404) 999-3710
- Fax
- (404) 999-3712
- NPI assigned
- Dec 5, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA004964 | GA | Primary |
Addresses
Primary practice location
1456 Church St
Decatur, GA 30030-1526
Mailing address
33900 Harper Ave Ste 104
Clinton TWP, MI 48035-4258
Phone (586) 350-2644
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA004964 | GA | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Team Rehabilitation Services, LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Marietta, GA
- NPI 1508538158
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1670198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688601600000",
"number": "1609586213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33900 HARPER AVE STE 104",
"city": "CLINTON TWP",
"state": "MI",
"postal_code": "480354258",
"telephone_number": "586-350-2644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1456 CHURCH ST",
"city": "DECATUR",
"state": "GA",
"postal_code": "300301526",
"telephone_number": "404-999-3710",
"fax_number": "404-999-3712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "BARBARA",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-12-05",
"last_updated": "2023-07-06",
"certification_date": "2023-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "GA",
"license": "PTA004964",
"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 Jul 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.