Citrine Therapy Source

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

CITRINE THERAPY SOURCE

Practice address

5678 Greensage Dr
College Park, GA 30349-8739

Phone

(678) 640-5396

NPI assigned

Sep 2, 2020

Last updated

Sep 2, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Laquanda White, PTNPI 1538348990

Title

Ceo/Physical Therapist

Phone

(678) 640-5396

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Laquanda Shuntay White, P.T.

  • Physical Therapist
  • College Park, GA
  • NPI 1538348990
  NPD Authorized official

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

{
    "created_epoch": "1599004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599004800000",
    "number": "1700490265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5678 GREENSAGE DR",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303498739",
            "telephone_number": "678-640-5396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5678 GREENSAGE DR",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303498739",
            "telephone_number": "678-640-5396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITRINE THERAPY SOURCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-02",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "LAQUANDA",
        "authorized_official_title_or_position": "CEO/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "678-640-5396",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in College Park, GA
• Providers in College Park, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 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.