Active NPI
Tabitha J Evans, PTA/OTA
- Physical Therapy Assistant
- Newnan, GA
National Provider Identifier
1912399304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 20510
- Practice address
- 130 Corn Crib Dr
Newnan, GA 30263-6076 - Phone
- (561) 667-0120
- NPI assigned
- Feb 23, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 13540 | FL | |
| Physical Therapy Assistant | 225200000X | 20510 | FL | Primary |
Addresses
Primary practice location
130 Corn Crib Dr
Newnan, GA 30263-6076
Mailing address
130 Corn Crib Dr
Newnan, GA 30263-6076
Phone (561) 667-0120
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 |
|---|---|---|---|
| 20510 | FL | MD | Clinical Social Worker |
| 13540 | FL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424649600000",
"number": "1912399304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 CORN CRIB DR",
"city": "NEWNAN",
"state": "GA",
"postal_code": "302636076",
"telephone_number": "561-667-0120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 CORN CRIB DR",
"city": "NEWNAN",
"state": "GA",
"postal_code": "302636076",
"telephone_number": "561-667-0120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "TABITHA",
"middle_name": "J",
"name_prefix": "Mrs.",
"credential": "PTA/OTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-23",
"last_updated": "2015-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "FL",
"license": "13540",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "20510",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newnan, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.