Active NPI
Stephanie Rachel Charleville, PT
- Physical Therapist
- Atlanta, GA
National Provider Identifier
1902180680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT009482
- Practice address
- 5529 Glenridge Park NE
Atlanta, GA 30342-1792 - Phone
- (678) 848-9551
- NPI assigned
- Sep 29, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 Therapist | 225100000X | PT009482 | GA | Primary |
Addresses
Primary practice location
5529 Glenridge Park NE
Atlanta, GA 30342-1792
Mailing address
4855 River Green Pkwy
Suite 130
Duluth, GA 30096-8336
Phone (770) 988-2779
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 |
|---|---|---|---|
| PT009482 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317254400000",
"number": "1902180680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4855 RIVER GREEN PKWY",
"address_2": "SUITE 130",
"city": "DULUTH",
"state": "GA",
"postal_code": "300968336",
"telephone_number": "770-988-2779",
"fax_number": "678-730-0229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5529 GLENRIDGE PARK NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303421792",
"telephone_number": "678-848-9551"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHARLEVILLE",
"first_name": "STEPHANIE",
"middle_name": "RACHEL",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-29",
"last_updated": "2011-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT009482",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.