RE GENERATE PHYSIOTHERAPY, LLC (NPI# 1558853085) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558853085 |
| Entity Type | Organization |
| Organization Name | RE GENERATE PHYSIOTHERAPY, LLC |
| Practice Address |
1240 Ga-54 Building 700 Fayetteville GA 30214 |
| Mailing Address |
250 Essex Circle Fayetteville GA 30215 |
| Practice Telephone | 6785060196 |
| Practice Fax Number | 7066110436 |
| Mailing Telephone | 6785060196 |
| Mailing Fax Number | 7066610436 |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2018-05-31 |
| Authorized Official Name | DR. JENNIFER MCGOWAN (BUSINESS OWNER/PHYSICAL THERAPIST) |
| Authorized Official Telephone | 6785060196 |
| Authorized Official Credential | PT, DPT, OCS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2251X0800X |
Physical Therapist Specialization: Orthopedic |
PT011852 | GA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
1240 GA-54 BUILDING 700 |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 2251X0800X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Orthopedic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871100479 | Production Physicos,llc | Physical Therapist | 461 Sandy Creek Rd Ste 1102, Fayetteville, GA 30214-4284 | 2020-09-28 |
| 1922063932 | Laura M. Yolitz | Physical Therapist | 135 Brandywine Blvd, Suite D, Fayetteville, GA 30214-1590 | 2006-04-20 |
| 1750865044 | Ruth Ross | Physical Therapist | 1125 N College Ave, Fayetteville, AR 72703-1908 | 2018-09-21 |
| 1700236221 | Joshua D Staggs | Physical Therapist | 3900 N Parkview Dr, Fayetteville, AR 72703-6398 | 2016-06-15 |
| 1063826154 | Zachary Allen Snow | Physical Therapist | 3900 N Parkview Dr, Fayetteville, AR 72703-6398 | 2014-06-17 |
| 1942647300 | Le-ann Mancio | Physical Therapist | 4140 Ferncreek Dr, Fayetteville, NC 28314-2563 | 2013-05-25 |
| 1376890053 | Kimberly Rose Ennis | Physical Therapist | 3317 N Wimberly Dr, 2nd Floor, Fayetteville, AR 72703-4056 | 2012-08-13 |
| 1447529797 | Joel D. Sattgast | Physical Therapist | 5400 Ramsey St, Fayetteville, NC 28311-1420 | 2011-12-15 |
| 1528024395 | Amanda C. Kinley | Physical Therapist | 1336 Highway 54 W, Bldg 500, Fayetteville, GA 30214-4535 | 2006-04-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710593819 | David Spellings | Physical Therapist | 3991 Us-78, Suite 200, Snellville, GA 30039 | 2020-09-23 |
| 1841801644 | Noah Konner Lindsey | Physical Therapist | 5270 Peachtree Pkwy Ste 116, Norcross, GA 30092-2558 | 2020-08-14 |
| 1942810106 | Caitlin M Hesse | Physical Therapist | 4480 S Cobb Dr Se Ste Y, Smyrna, GA 30080-6984 | 2020-08-03 |
| 1669007316 | Dynamic Swing Performance, LLC | Physical Therapist | 2031 Cobblestone Cir Ne, Brookhaven, GA 30319-4909 | 2020-03-03 |
| 1356810113 | Ryan Daniel Ahlenius | Physical Therapist | 6360 Dove Dr, Loganville, GA 30052-3031 | 2018-11-21 |
| 1720557127 | Dr. Tiffany Lamonde LLC | Physical Therapist | 1445 Haw Creek Circle, Suite 503, Cumming, GA 30041 | 2018-11-15 |
| 1700363686 | Jason Y Kawamura | Physical Therapist | 2300 Liam Ave Ste 103, Dacula, GA 30019-2265 | 2018-07-24 |
| 1649766528 | Carrie Elizabeth Dendtler | Physical Therapist | 320 Montgomery Ave, Alpharetta, GA 30004-3163 | 2018-07-03 |
| 1407363328 | Berkeley Van Dyke | Physical Therapist | 6335 Hospital Pkwy Ste 316, Johns Creek, GA 30097 | 2017-12-30 |
| 1598287609 | Lance Frank | Physical Therapist | 755 Commerce Dr Ste 712, Decatur, GA 30030-2621 | 2017-07-11 |
| Find all providers with the same taxonomy | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
Please comment or provide details below to improve the information on RE GENERATE PHYSIOTHERAPY, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.