NPIMap

Organization Active NPI

Tri State Rehabilitation Inc

Doing business as Valdosta Pediatric Therapy Services

  • Speech-Language Pathologist
  • Valdosta, GA
National Provider Identifier
1629121272
Registry record updated Jul 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
005367 Issued in GA
Legal business name
TRI STATE REHABILITATION INC
Doing business as
Valdosta Pediatric Therapy Services
Practice address
202 W Park Ave
Valdosta, GA 31602-2507
Phone
(229) 253-8500
Fax
(229) 253-8522
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2007

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

Authorized official

Name
Mrs. Kathryn Reagan, CCC-SLP
Title
Speech and Language Pathologist
Phone
(229) 253-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X 005367 GA Primary

Addresses

Primary practice location

202 W Park Ave
Valdosta, GA 31602-2507

Mailing address

202 W Park Ave
Valdosta, GA 31602-2507
Phone (229) 253-8500

Other identifiers 1

IdentifierTypeStateIssuer
52171814OtherGABLUE CROSS BLUE SHIELD

Other names 1

  • Valdosta Pediatric Therapy Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Tri State Rehabilitation Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184544000000",
    "number": "1629121272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 W PARK AVE",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022507",
            "telephone_number": "229-253-8500",
            "fax_number": "229-253-8522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 W PARK AVE",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022507",
            "telephone_number": "229-253-8500",
            "fax_number": "229-253-8522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI STATE REHABILITATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-07-16",
        "status": "A",
        "authorized_official_last_name": "REAGAN",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_title_or_position": "SPEECH AND LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "229-253-8500",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "005367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "52171814",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valdosta Pediatric Therapy Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; 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.