NPIMap

Organization Active NPI

Sundance Rehabilitation Agency, LLC

  • Rehabilitation Clinic/Center
  • Johns Creek, GA
National Provider Identifier
1760437743
Registry record updated Dec 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
License
N/A
Legal business name
SUNDANCE REHABILITATION AGENCY, LLC
Practice address
11405 Medlock Bridge Rd
Johns Creek, GA 30097-1688
Phone
(470) 299-5049
NPI assigned
May 24, 2006
Organization subpart
Yes
Parent organization
SUNDANCE REHABILITATION CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 12, 2025

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

Authorized official

Name
Ian Oppel
Title
Coo
Phone
(980) 254-7007

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X N/A Primary

Addresses

Primary practice location

11405 Medlock Bridge Rd
Johns Creek, GA 30097-1688

Mailing address

101 E State St
Kennett Square, PA 19348-3109
Phone (800) 728-8808

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050520000309 GA Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 5698683498 Practice locations: Atlanta, GA; Johns Creek, GA

Outpatient physical therapy / speech pathology certification: CCN 116849

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SUNDANCE GEORGIA REHABILITATION AGENCY
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Oct 15, 2003
Last certification
Dec 27, 2021
Ownership / control type
Proprietary
Facility address
11405 Medlock Bridge Road
Duluth, GA 30097

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Sundance Rehabilitation Agency LLC13 organizations share this tax ID, including this one
Part of
Sundance Rehab Corp

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1479 Grove Park Dr
Columbus, GA 31904
Phone (706) 222-7188

63 Lee St
Winder, GA 30680
Phone (678) 425-0718

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765497600000",
    "number": "1760437743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E STATE ST",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193483109",
            "telephone_number": "800-728-8808",
            "fax_number": "610-347-4147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11405 MEDLOCK BRIDGE RD",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300971688",
            "telephone_number": "470-299-5049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDANCE REHABILITATION AGENCY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNDANCE REHABILITATION CORPORATION",
        "enumeration_date": "2006-05-24",
        "last_updated": "2025-12-12",
        "certification_date": "2025-12-12",
        "status": "A",
        "authorized_official_last_name": "OPPEL",
        "authorized_official_first_name": "IAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "980-254-7007"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": "N/A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johns Creek, GA

Sources for this page

Verify at the official NPI Registry.