NPIMap

Organization Active NPI

Back in the Game Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Flowery Branch, GA
National Provider Identifier
1962669275
Registry record updated Nov 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
BACK IN THE GAME PHYSICAL THERAPY, INC
Practice address
4754 Martin Rd
Suite 200
Flowery Branch, GA 30542-3507
Phone
(770) 967-4377
Fax
(770) 967-8077
NPI assigned
May 22, 2008
Last updated
Nov 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2011

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

Authorized official

Name
Gina Renee Blake, PTNPI 1053596569
Title
Co-Owner
Phone
(678) 570-2584

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

4754 Martin Rd
Suite 200
Flowery Branch, GA 30542-3507

Mailing address

4754 Martin Rd
Suite 200
Flowery Branch, GA 30542-3507
Phone (770) 967-4377

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120419000722 GA Part B Supplier - Clinic/Group Practice 9133380082 Receives reassigned benefits from 18 practitioners
Practice locations: Flowery Branch, GA; Dacula, GA; Suwanee, GA; Gainesville, GA

National Provider Directory

National Provider Directory

Locations

2300 Liam Ave
Dacula, GA 30019
Phone (470) 294-0052

4754 Martin Rd
#200
Flowery Branch, GA 30542
Phone (770) 967-4377

2335 Limestone Overlook
Ste C
Gainesville, GA 30501
Phone (770) 967-4377

2480 Limestone Pkwy
Ste 107
Gainesville, GA 30501
Phone (770) 967-4377

2800 Horizon Ridge Ct
Ste 250
Suwanee, GA 30024
Phone (678) 505-1995

415 Horizon Dr
Ste 250
Suwanee, GA 30024
Phone (678) 505-1995

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1211414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321315200000",
    "number": "1962669275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4754 MARTIN RD",
            "address_2": "SUITE 200",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305423507",
            "telephone_number": "770-967-4377",
            "fax_number": "770-967-8077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4754 MARTIN RD",
            "address_2": "SUITE 200",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305423507",
            "telephone_number": "770-967-4377",
            "fax_number": "770-967-8077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK IN THE GAME PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-22",
        "last_updated": "2011-11-15",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "678-570-2584",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flowery Branch, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.