MEDICARE: MIDDLE GA ORTHOPEADIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	000450	GA

General Provider Information

NPI Number	:	1154546786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDDLE GA ORTHOPEADIC

Provider Business Mailing Address
First Line	:	3370 ROSA CT
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31216-6737
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3051 WATSON BLVD STE 400
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-8556
Country	:	US
Telephone Number	:	478-953-7556
Fax Number	:

Authorized Official
Title or Position	:	FUNCTIONAL CAPACITY EVALUATOR
Name	:	BRIAN THARPE
Credential	:	COTA, CEAS, CFCE
Telephone Number	:	478-953-7556

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/22/2020

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Directions to “MIDDLE GA ORTHOPEADIC ” Practice Location

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