Active NPI
Alyse Mahfouz
- Physical Therapy Assistant
- Roswell, GA
National Provider Identifier
1629781737
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA004905
- Practice address
- 500 Walton Way
Roswell, GA 30076-3418 - Phone
- (770) 649-7452
- NPI assigned
- Jan 4, 2023
- 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 | PTA004905 | GA | Primary |
Addresses
Primary practice location
500 Walton Way
Roswell, GA 30076-3418
Mailing address
7860 Trailside Way
Gainesville, GA 30506-7045
Phone (770) 362-8570
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 |
|---|---|---|---|
| PTA004905 | GA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672790400000",
"number": "1629781737",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7860 TRAILSIDE WAY",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305067045",
"telephone_number": "770-362-8570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 WALTON WAY",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300763418",
"telephone_number": "770-649-7452"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHFOUZ",
"first_name": "ALYSE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-04",
"last_updated": "2023-01-04",
"certification_date": "2023-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "GA",
"license": "PTA004905",
"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 Jan 4, 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.