NPIMap

Organization Active NPI

Premier Childrens Therapy Center

  • Physical Therapist
  • Roswell, GA
National Provider Identifier
1649462961
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PREMIER CHILDRENS THERAPY CENTER
Practice address
1000 Holcomb Woods Pkwy Ste 422
Roswell, GA 30076-4718
Phone
(770) 641-8070
Fax
(770) 641-8078
NPI assigned
Aug 10, 2007
Last updated
Jul 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Authorized official

Name
Jennifer F Kovanis, MS OTR/LNPI 1306925714
Title
President
Phone
(770) 641-8070

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary
Pediatric Physical Therapist 2251P0200X NU
Occupational Therapist 225X00000X NU
Pediatric Occupational Therapist 225XP0200X NU
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

1000 Holcomb Woods Pkwy Ste 422
Roswell, GA 30076-4718

Mailing address

700 Amster Green Dr
Atlanta, GA 30350-4139
Phone (770) 641-8070

Other identifiers 1

IdentifierTypeStateIssuer
300035640AMedicaidGA

National Provider Directory

National Provider Directory

Locations

1000 Holcomb Woods Pkwy
Ste 426
Roswell, GA 30076
Phone (770) 641-8070

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1186704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1649462961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 AMSTER GREEN DR",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303504139",
            "telephone_number": "770-641-8070",
            "fax_number": "770-641-8078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HOLCOMB WOODS PKWY STE 422",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764718",
            "telephone_number": "770-641-8070",
            "fax_number": "770-641-8078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER CHILDRENS THERAPY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-10",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "KOVANIS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-641-8070",
        "authorized_official_credential": "MS OTR/L"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300035640A",
            "state": "GA"
        }
    ],
    "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 Jul 12, 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.

Verify at the official NPI Registry.