Jessie W. Cavazos, DPT, OCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT011804 Issued in GA

Practice address

655 Molly LN
Suite 100
Woodstock, GA 30189-6503

Phone

(770) 517-1080

NPI assigned

Sep 16, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Jessie S Wenzel Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Lifestyle Rehabilitation LLC

  • Physical Therapist
  • New York, NY
  • NPI 1578431086
  NPD

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

{
    "created_epoch": "1221523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511827200000",
    "number": "1801045737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "546 LOST CREEK DR",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301881631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 MOLLY LN",
            "address_2": "SUITE 100",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301896503",
            "telephone_number": "770-517-1080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAVAZOS",
        "first_name": "JESSIE",
        "middle_name": "W.",
        "credential": "DPT, OCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-16",
        "last_updated": "2017-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "24212",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "031754",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT011804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSIE",
            "last_name": "WENZEL",
            "middle_name": "S",
            "credential": "DPT, OCS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Steven Castellanos, PHARMD
• Deidra Lynn Castillo, COTA/L
• Stephanie Castillo
• Alexis Catlett, MD
• Jennifer Caupain, OTR
• Mia Lynn Cellino, LPMT, MT-BC
• Cheyenne Ceniceros, SLP
• Centerpoint Therapeutic Services, Inc.
• Centerwell Senior Primary Care Ga PC
• Centre for Transitional Change LLC

• Physical Therapist in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2017; 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.