Healthcare Provider Details

I. General information

NPI: 1245155514
Provider Name (Legal Business Name): JADE FREEMAN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 LEE ST
ROYSTON GA
30662-2720
US

IV. Provider business mailing address

4054 SALEM RD
ROYSTON GA
30662-3487
US

V. Phone/Fax

Practice location:
  • Phone: 706-680-2172
  • Fax:
Mailing address:
  • Phone: 706-680-2172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT018530
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: