Blaine Woody, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT003406 Issued in GA

Practice address

4325 Atlanta Hwy
Suite 15
Loganville, GA 30052-2341

Phone

(770) 466-3100

Fax

(770) 466-3105

NPI assigned

Jun 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Matrix Rehabilitation - Georgia, Inc.

  • Physical Therapy Clinic/Center
  • Loganville, GA
  • NPI 1942231378
  NPD (past)
• Matrix Rehabilitation-Georgia Inc

  • Physical Therapy Clinic/Center
  • McDonough, GA
  • NPI 1659302966
  NPD (past)

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922043173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "448 MAPLE COURT RIDGE",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "30052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4325 ATLANTA HWY",
            "address_2": "SUITE 15",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522341",
            "telephone_number": "770-466-3100",
            "fax_number": "770-466-3105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODY",
        "first_name": "BLAINE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT003406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joy Stanetrice Wilson, FNP-BC
• Kenneth L Wilson
• Thomas Christopher Wilson, PT
• Jeongi Won
• Marlaina Grant Woodward, BSED
• Magualie Woollery, D.M.D.
• Bayyinah Wright, APRN
• Xala X Yang, APNP
• Aisa Yarns, RN, RRT
• Sarah Yikealo, M.S., CCC-SLP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.