PHYSICAL THERAPY PROS, LLC
Complete NPI Record 1609207885
Physical Therapist - Electrophysiology, Clinical in Savannah, GA

Active since December 12, 2013

140 JOHNNY MERCER BLVD STE 10A, SAVANNAH, GA 31410(404) 590-5366(470) 809-1582 Get Directions

NPPES record last updated: April 6, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 6, 2026, May 19, 2025, May 16, 2025 and 9 more (12 updates tracked since 2017).

Complete NPI Dataset

This page contains the complete raw NPPES record for Physical Therapy Pros, Llc (NPI 1609207885), a physical therapist organization in Savannah, GA. All 46 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.

Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.

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Registry File Document Utilities

NPI: 1609207885: The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2: Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: Not available: The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business Name: PHYSICAL THERAPY PROS, LLC: The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: PO BOX 1157: The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City Name: JACKSON: The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: GA: The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code: 302330024: The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Country Code If outside U S : US: The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
Provider Business Mailing Address Telephone Number: 7063256971: The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number: 4708091582: The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Provider First Line Business Practice Location Address: 140 JOHNNY MERCER BLVD STE 10A: The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: SAVANNAH: The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: GA: The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 314102169: The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US: The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 4045905366: The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 4708091582: The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 12/12/2013: The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 4/6/2026: The date that a record was last updated or changed.
Authorized Official Last Name: MCKIBBEN: The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: RICHARD: The first name of the authorized official.
Authorized Official Middle Name: J: The middle name of the authorized official.
Authorized Official Title or Position: OWNER: The title or position of the authorized official.
Authorized Official Telephone Number: 7063256971: The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 2251X0800X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: PT008390: The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
Provider License Number State Code 1: GA: The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
Healthcare Provider Primary Taxonomy Switch 1: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 2: 225100000X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 2: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 3: 2251S0007X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 3: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 4: 2251E1300X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 4: PT008390: The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
Provider License Number State Code 4: GA: The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
Healthcare Provider Primary Taxonomy Switch 4: Y: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Other Provider Identifier 1: 003175864A: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 1: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 1: GA: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Is Organization Subpart: N: Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
NPI Certification Date: 4/6/2026: The date on which the National Provider Identifier (NPI) was officially assigned and certified to the provider. This reflects when the provider's NPI record first became active in the NPPES system.

Secondary Practice Locations 25

The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.

3300 Herons Glen Blvd Ft

1/25

Myers, FL 33917 · Phone (470) 809-1581 · Fax (470) 809-1582

1544 Route 61 Hwy S Ste 6174

2/25

Pottsville, PA 17901-4208 · Phone (470) 809-1581 · Fax (470) 809-1582

1107 Greer St Ste A

3/25

Cordele, GA 31015-1921 · Phone (404) 590-5366 · Fax (470) 809-1582

7351 Old Moon Rd

4/25

Columbus, GA 31909-7291 · Phone (404) 590-5366 · Fax (470) 809-1582

1000 Hillcrest Pkwy

5/25

Dublin, GA 31021-4208 · Phone (404) 590-5366 · Fax (470) 809-1582

55 Cantrell Rd Ste 100

6/25

Cleveland, GA 30528-1083 · Phone (404) 590-5366 · Fax (470) 809-1582

4216 Washington Rd Ste 2

7/25

Evans, GA 30809-4717 · Phone (404) 590-5366 · Fax (470) 809-1582

840 Pine St Ste 880

8/25

Macon, GA 31201-7525 · Phone (404) 590-5366 · Fax (470) 809-1582

2109 N Patterson St

9/25

Valdosta, GA 31602-2990 · Phone (404) 590-5366 · Fax (470) 809-1582

312 Margie Dr # 800

10/25

Warner Robins, GA 31088-8913 · Phone (404) 590-5366 · Fax (470) 809-1582

1805 Vernon Rd Ste A

11/25

LaGrange, GA 30240-3871 · Phone (404) 590-5366 · Fax (470) 809-1582

670 North Ave NW Ste 201

12/25

Marietta, GA 30060-1100 · Phone (404) 590-5366 · Fax (470) 809-1582

3300 Herons Glen Blvd

13/25

North Fort Myers, FL 33917-6719 · Phone (404) 590-5366 · Fax (470) 809-1582

535 Glynn St S Ste 2008

14/25

Fayetteville, GA 30214-2029 · Phone (404) 590-5366 · Fax (470) 809-1582

775 Poplar Rd Ste 350

15/25

Newnan, GA 30265-8304 · Phone (404) 590-5366 · Fax (470) 809-1582

304 Jones Ave

16/25

Waynesboro, GA 30830-1509 · Phone (404) 590-5366 · Fax (470) 809-1582

1430 US Highway 82 W Ste 103

17/25

Tifton, GA 31793-8010 · Phone (404) 590-5366 · Fax (470) 809-1582

1556 E Forsyth St Ste A

18/25

Americus, GA 31709-3334 · Phone (404) 590-5366 · Fax (470) 809-1582

403 Hillcrest Dr Ste A

19/25

Easley, SC 29640-1207 · Phone (404) 590-5366 · Fax (470) 809-1582

3939 Roswell Rd Ste 240

20/25

Marietta, GA 30062-6285 · Phone (470) 809-1581 · Fax (470) 809-1582

3901 National Dr Ste 100

21/25

Burtonsville, MD 20866-1176 · Phone (404) 590-5366 · Fax (470) 809-1582

371 Noah Dr Ste 102

22/25

Jasper, GA 30143-8708 · Phone (404) 590-5366 · Fax (470) 809-1582

1650 Skylyn Dr Ste 380

23/25

Spartanburg, SC 29307-1087 · Phone (404) 590-5366 · Fax (470) 809-1582

10591 Veneto Dr

24/25

Fort Myers, FL 33913-7021 · Phone (404) 590-5366 · Fax (470) 809-1582

3913 Georgetown Rd NW

25/25

Cleveland, TN 37312-1806 · Phone (404) 590-5366 · Fax (470) 809-1582

Other Provider Identifiers 1

Legacy and payer-issued identifiers reported to the NPPES registry for this provider.

003175864A Medicaid

1/1

State: GA
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

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