CMS-1500 Box 24J / 33a • NPI
1093561656
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
2081P0010X (CMS 25)
Licensed & Credentialed Allopathic & Osteopathic Physicians — Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine
Box 32 Service Location & ZIP+4
1130 SENOIA RD STE A1, TYRONE, GA, 30290-1640
✓ 9-Digit EDI 837 ZIP+4 (30290-1640)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1093561656 (ACTIVEKIDZ AND ADULT THERAPY SERVICES) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1093561656 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | ACTIVEKIDZ AND ADULT THERAPY SERVICES |
| Plain-English Specialty | Licensed & Credentialed Allopathic & Osteopathic Physicians — Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine NUCC Code: 2081P0010X (Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 1130 SENOIA RD STE A1, TYRONE, GA, 30290-1640 |
| Practice Telephone / Fax | Tel: (678) 632-6765 |
| Administrative Mailing Address | 1431 CAPITAL AVE STE 123, WATKINSVILLE, GA, 30677-1883 |
| Enumeration & Last Sync | Enumerated: 2024-04-25 | CMS Record Updated: 2024-04-25 |
| Authorized Official | SUSAN COOK (Owner) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (2081P0010X)
What Does Taxonomy Code 2081P0010X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 2081P0010X translates to:
"Licensed & Credentialed Allopathic & Osteopathic Physicians — Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (ACTIVEKIDZ AND ADULT THERAPY SERVICES)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
2081P0010X — Physical Medicine & Rehabilitation, Pediatric Rehabilitation MedicinePlain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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