NPIMap

Organization Active NPI

Pediatric Rehabilitation and Wellness LLC

  • Pediatric Physical Therapist
  • Savannah, GA
National Provider Identifier
1669785580
Registry record updated Jul 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
PT 009479 Issued in GA
Legal business name
PEDIATRIC REHABILITATION AND WELLNESS LLC
Practice address
106 Oglethorpe Professional CT
Suite a
Savannah, GA 31406-3695
Phone
(912) 351-4793
Fax
(888) 429-3741
NPI assigned
Jul 20, 2010
Last updated
Jul 31, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2020

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

Authorized official

Name
Thea E. JackNPI 1336352079
Title
Owner/Physical Therapist
Phone
(912) 713-0277

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X PT 009479 GA Primary
Occupational Therapist 225X00000X OT004895 GA
Pediatric Occupational Therapist 225XP0200X OT002973 GA

Addresses

Primary practice location

106 Oglethorpe Professional CT
Suite a
Savannah, GA 31406-3695

Mailing address

10 Mall CT Ste B
Savannah, GA 31406-3691
Phone (912) 351-4793

National Provider Directory

National Provider Directory

Locations

10 Mall Ct
Ste B
Savannah, GA 31406
Phone (912) 351-4793

106 Oglethorpe Professional Ct
Ste A
Savannah, GA 31406
Phone (912) 351-4793

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1279584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596153600000",
    "number": "1669785580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 MALL CT STE B",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314063691",
            "telephone_number": "912-351-4793",
            "fax_number": "888-429-3741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 OGLETHORPE PROFESSIONAL CT",
            "address_2": "SUITE A",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314063695",
            "telephone_number": "912-351-4793",
            "fax_number": "888-429-3741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC REHABILITATION AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-20",
        "last_updated": "2020-07-31",
        "certification_date": "2020-07-31",
        "status": "A",
        "authorized_official_last_name": "JACK",
        "authorized_official_first_name": "THEA",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "912-713-0277"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "GA",
            "license": "PT 009479",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "OT004895",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "GA",
            "license": "OT002973",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; 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.