Matrix Rehabilitation - Georgia, Inc.

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

MATRIX REHABILITATION - GEORGIA, INC.

Doing business as

Progressive Sports Medicine-Loganville

Practice address

4325 Atlanta Hwy
Suite 15
Loganville, GA 30052-3264

Phone

(770) 466-3100

Fax

(770) 466-3105

NPI assigned

Jul 5, 2006

Last updated

Feb 4, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dennis J. Fitzpatrick

Title

Cheif Financial Officer

Phone

(610) 644-7824

Specialties & licenses 1

Addresses

Other names 1

• Progressive Sports Medicine-Loganville Doing business as

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tammy Petty, P.T.

  • Physical Therapist
  • Loganville, GA
  • NPI 1538100938
  NPD (past)
• Blaine Woody, PT

  • Physical Therapist
  • Loganville, GA
  • NPI 1922043173
  NPD (past)

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202083200000",
    "number": "1942231378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "665 PHILADELPHIA ST",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157013941",
            "telephone_number": "724-465-3496",
            "fax_number": "724-465-3726"
        },
        {
            "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": "300523264",
            "telephone_number": "770-466-3100",
            "fax_number": "770-466-3105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATRIX REHABILITATION - GEORGIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2008-02-04",
        "status": "A",
        "authorized_official_last_name": "FITZPATRICK",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CHEIF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "610-644-7824"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Progressive Sports Medicine-Loganville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aquesha Martin, MS, OTR/L
• Caitlin Culver Martin
• Jodi-Ann Masilo, LCSW
• Jennifer Mask
• Carey Campbell Mathurin
• Gabriele Mayes, LMFT
• Daniel McCance, LPC
• Derek McClasky
• Lakeisha McCray, MS ED.
• Tanisha McDonald

• Physical Therapy Clinic/Center in Loganville, GA
• Providers in Loganville, GA by specialty
• Physical Therapy Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2008; 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.