NPIMap

Organization Active NPI

Proactive Physical Therapy and Rehabilitation LLC

  • Physical Therapy Clinic/Center
  • Augusta, GA
National Provider Identifier
1902102452
Registry record updated Jul 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
PROACTIVE PHYSICAL THERAPY AND REHABILITATION LLC
Practice address
2103 Reedale Ave
Augusta, GA 30906-3430
Phone
(706) 814-6887
Fax
(706) 814-6587
NPI assigned
Feb 1, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2011

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

Authorized official

Name
Diane R Wilson
Title
PT
Phone
(706) 814-6887

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

2103 Reedale Ave
Augusta, GA 30906-3430

Mailing address

2103 Reedale Ave
Augusta, GA 30906-3430
Phone (706) 814-6887

National Provider Directory

National Provider Directory

Locations

2103 Reedale Ave
Augusta, GA 30906
Phone (706) 414-5058

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1296518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310947200000",
    "number": "1902102452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 REEDALE AVE",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309063430",
            "telephone_number": "706-814-6887",
            "fax_number": "706-814-6587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 REEDALE AVE",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309063430",
            "telephone_number": "706-814-6887",
            "fax_number": "706-814-6587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE PHYSICAL THERAPY AND REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-01",
        "last_updated": "2011-07-18",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PT",
        "authorized_official_telephone_number": "706-814-6887"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2011; 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.