Individual provider Active NPI

Charla Neoma Nelson, DPT

  • Physical Therapist
  • Alpharetta, GA
National Provider Identifier
1689639924
Registry record updated Jan 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
7761 Issued in AZ
Practice address
6505 Shiloh Rd Ste 100
Alpharetta, GA 30005-1645
Phone
(678) 648-7644
NPI assigned
Apr 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 7761 AZ Primary

Addresses

Primary practice location

6505 Shiloh Rd Ste 100
Alpharetta, GA 30005-1645

Mailing address

20261 E Ocotillo Rd
Suite 110
Queen Creek, AZ 85142-8806
Phone (480) 677-2771

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181022003390 GA Practitioner - Physical Therapist in Private Practice 8820184351 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7761AZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Elite Medical Partners PLLC CurrentSince Jun 1, 2021 Accepting new patients
Legacy Healthcare Services Inc Physical Therapist CurrentSince Aug 24, 2021 Accepting new patients
Legacy Healthcare Services, Inc. Physical Therapist CurrentSince Aug 24, 2021 Accepting new patients
Therapyland LLC Past Accepting new patients

Locations

20261 E Ocotillo Rd
Ste 110
Queen Creek, AZ 85142
Phone (480) 677-2771

3769 Kallie Cir
Dawsonville, GA 30534
Phone (419) 540-9011

110 Horizon Dr
Ste 310
Raleigh, NC 27615
Phone (970) 215-3300

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1689639924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20261 E OCOTILLO RD",
            "address_2": "SUITE 110",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851428806",
            "telephone_number": "480-677-2771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6505 SHILOH RD STE 100",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300051645",
            "telephone_number": "678-648-7644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "CHARLA",
        "middle_name": "NEOMA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-19",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "7761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpharetta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.