MATRIX REHABILITATION-GEORGIA, INC. (NPI# 1679519219) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679519219 |
| Entity Type | Organization |
| Organization Name | MATRIX REHABILITATION-GEORGIA, INC. |
| Other Organization Name | PROGRESSIVE SPORTS MEDICINE |
| Practice Address |
355 Philip Blvd Suite B Lawrenceville GA 30045-8733 |
| Mailing Address |
665 Philadelphia St Indiana PA 15701-3941 |
| Practice Telephone | 7705133233 |
| Practice Fax Number | 7705132905 |
| Mailing Telephone | 7244653496 |
| Mailing Fax Number | 7244653726 |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2008-02-04 |
| Authorized Official Name | DENNIS J. FITZPATRICK (CHEIF FINANCIAL OFFICER) |
| Authorized Official Telephone | 6106447824 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Progressive Sports Medicine | Doing Business As Name - Organization |
| Street Address |
355 PHILIP BLVD SUITE B |
| City | LAWRENCEVILLE |
| State | GA |
| Zip Code | 30045-8733 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316981376 | Molly D. Patel | Physical Therapist | 355 Philip Blvd, Suite B, Lawrenceville, GA 30045-8733 | 2006-06-16 |
| 1154852820 | Sleep Ezzy | Anesthesiology | 355 Philip Blvd, B, Lawrenceville, GA 30046-8733 | 2017-03-24 |
| 1184725814 | Alfred August Williams | Specialist | 355 Philip Blvd, Suite A, Lawrenceville, GA 30046-8733 | 2006-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285104315 | Shalanda Monique Booker | Counselor | 2940 Emerald Springs Drive, Lawrenceville, GA 30045 | 2018-12-02 |
| 1669957320 | Chantelle S Fuller | Behavioral Analyst | 805 Donington Cir, Lawrenceville, GA 30045 | 2018-09-28 |
| 1356836035 | Gad Health Care LLC | Home Health | 1140 Great Oaks Dr, Lawrenceville, GA 30045 | 2018-06-26 |
| 1346668662 | Eca Optical, LLC | Eyewear Supplier (Equipment, not the service) | 601-a Professional Drive, Ste 170, Lawrenceville, GA 30045 | 2014-04-03 |
| 1598102733 | Selena Fuller | Nurse Practitioner | 181 South Clayton Street, Lawrenceville, GA 30045 | 2013-05-29 |
| 1942555982 | Vida Michele James-bryant | Community Health Worker | 1309 Avington Glen Dr, Lawrenceville, GA 30045 | 2012-07-16 |
| 1770840639 | Rebecca Vinson D'angelo | Occupational Therapist | 1518 Great Shoals Cir, Lawrenceville, GA 30045 | 2012-04-17 |
| 1427346774 | Amanda Michelel Woods | Psychologist | 285 South Perry Street, Lawrenceville, GA 30045 | 2011-07-20 |
| 1790070563 | M & G Pharmacy Inc | Pharmacy | 100 Hurricane Shoals Rd Suite F, Lawrenceville, GA 30045 | 2011-06-09 |
| 1306146154 | Thanh Dau | Optometrist | 1250 Scenic Highway, Ste 1268, Lawrenceville, GA 30045 | 2010-10-27 |
| Find all providers in zip 30045 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285243824 | Bryan Carestia, Pt, Dpt, Cscs | Clinic/Center | 26 Tamar Ct, Lawrenceville, NJ 08648-1582 | 2020-07-29 |
| 1942853916 | Core Care Women's & Children's Wellness Physical Therapy, LLC | Clinic/Center | 1585 Old Norcross Rd Ste 207b, Lawrenceville, GA 30046-4043 | 2019-07-18 |
| 1073522538 | Concentra Health Services, Inc. | Clinic/Center | 755 Lawrenceville Suwanee Rd, Suite 1600, Lawrenceville, GA 30043-7345 | 2006-08-05 |
| 1962981761 | Occupational Health Centers of New Jersey, P.a. | Clinic/Center | 2542 Brunswick Pike, Lawrenceville, NJ 08648 | 2018-08-13 |
| 1356845374 | Jmm Health Solutions, LLC | Clinic/Center | 480 Congress Pkwy, Lawrenceville, GA 30044-4579 | 2018-03-23 |
| 1912409046 | Grand Therapeutic Services LLC | Clinic/Center | 1600 Atkinson Rd Ste 111, Lawrenceville, GA 30043-5747 | 2018-03-05 |
| 1861921363 | Rachel Christie | Clinic/Center | 545 Old Norcross Rd Ste 100, Lawrenceville, GA 30046-3390 | 2017-06-08 |
| 1922379189 | 1source Fitness & Sports-neuro Rehab LLC | Clinic/Center | 1670 Mckendree Church Rd Ste 40, Lawrenceville, GA 30043-4100 | 2012-01-19 |
| 1972832772 | Elite Wellness Inc | Clinic/Center | 3315 Sugarloaf Pkwy, Suite 5, Lawrenceville, GA 30044-5497 | 2009-12-08 |
| 1487819330 | Concentra Health Services, Inc. | Clinic/Center | 860 Duluth Hwy, Suite 1600, Lawrenceville, GA 30043-5326 | 2008-07-21 |
| Find all providers in LAWRENCEVILLE | ||||
| City | LAWRENCEVILLE |
| Zip Code | 30045 |
Please comment or provide details below to improve the information on MATRIX REHABILITATION-GEORGIA, INC..
| 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.