NPIMap

Organization Active NPI

Sutherland Physical Therapy, Inc.

  • Pediatric Physical Therapist
  • Valdosta, GA
National Provider Identifier
1689730319
Registry record updated Oct 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
PT007469 Issued in GA
Legal business name
SUTHERLAND PHYSICAL THERAPY, INC.
Practice address
5108 Northwind Blvd
Valdosta, GA 31605-7672
Phone
(229) 244-1201
Fax
(229) 244-1207
NPI assigned
Dec 28, 2006
Last updated
Oct 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2015

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

Authorized official

Name
Mrs. Michelle Jennifer Sutherland, PTNPI 1306916416
Title
Physical Therapist
Phone
(229) 292-7426

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X PT007469 GA Primary

Addresses

Primary practice location

5108 Northwind Blvd
Valdosta, GA 31605-7672

Mailing address

5108 Northwind Blvd
Valdosta, GA 31605-7672
Phone (229) 244-1201

Other identifiers 1

IdentifierTypeStateIssuer
000957635CMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070412000057 GA Part B Supplier - Clinic/Group Practice 0042315582 Receives reassigned benefits from 9 practitioners
Practice locations: Valdosta, GA

National Provider Directory

National Provider Directory

Locations

3328 Bemiss Rd
Valdosta, GA 31605
Phone (229) 244-1201

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443744000000",
    "number": "1689730319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5108 NORTHWIND BLVD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316057672",
            "telephone_number": "229-244-1201",
            "fax_number": "229-244-1207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5108 NORTHWIND BLVD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316057672",
            "telephone_number": "229-244-1201",
            "fax_number": "229-244-1207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTHERLAND PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2015-10-02",
        "status": "A",
        "authorized_official_last_name": "SUTHERLAND",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "JENNIFER",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "229-292-7426",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "GA",
            "license": "PT007469",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000957635C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Oct 2, 2015; 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.