RE GENERATE PHYSIOTHERAPY LLC NPI 1558853085

NPI Information

  • NPI: 1558853085
  • Provider Name: RE GENERATE PHYSIOTHERAPY, LLC
  • Classification: Physical Therapist - 2251X0800X
  • Specialization: Orthopedic
  • Entity Type: Organization
  • CLIA Number: 11D2192321
  • Address: 1240 GA-54
    BUILDING 700
    FAYETTEVILLE, GA
    ZIP 30214
  • Phone: (678) 506-0196

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NPI Details

RE GENERATE PHYSIOTHERAPY, LLC is an orthopedic physical therapist in Fayetteville, GA. The provider is a licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Orthopaedic Physical Therapy, who has demonstrated specialized knowledge and skill in human anatomy and physiology, movement science; pathology/pathophysiology, pain science, medical and surgical considerations, orthopaedic physical therapy theory and practice, and critical inquiry for evidence-based practice. RE GENERATE PHYSIOTHERAPY, LLC NPI is 1558853085. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1240 GA-54
BUILDING 700
FAYETTEVILLE, GA
ZIP 30214
Phone: (678) 506-0196
Fax: (706) 611-0436

The provider's authorized official is Jennifer Mcgowan .
The authorized official title is Business Owner/physical Therapist and has the following contact phone number (678) 506-0196.

The CLIA number assigned to this NPI record is 11D2192321 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 5/31/2018 and was last updated on 5/31/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12251X0800XPhysical TherapistOrthopedicPT011852GEORGIAYes

What is NPI?

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This page was last updated on: 11/21/2025

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