Active NPI
Matthew Ntomoo Lo, PTA
- Physical Therapy Assistant
- Grayson, GA
National Provider Identifier
1811482201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA004052
- Practice address
- 2065 Grayson Hwy Ste B
Grayson, GA 30017 - Phone
- (678) 376-0213
- Fax
- (678) 376-0215
- NPI assigned
- Jun 27, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA004052 | GA | Primary |
Addresses
Primary practice location
2065 Grayson Hwy Ste B
Grayson, GA 30017
Mailing address
6397 Lee Hwy Ste 300
Chattanooga, TN 37421-2564
Phone (423) 238-7217
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA004052 | GA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532995200000",
"number": "1811482201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6397 LEE HWY STE 300",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374212564",
"telephone_number": "423-238-7217",
"fax_number": "423-362-8684"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2065 GRAYSON HWY STE B",
"city": "GRAYSON",
"state": "GA",
"postal_code": "30017",
"telephone_number": "678-376-0213",
"fax_number": "678-376-0215"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LO",
"first_name": "MATTHEW",
"middle_name": "NTOMOO",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-27",
"last_updated": "2018-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "GA",
"license": "PTA004052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grayson, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.