Healthcare Provider Details

I. General information

NPI: 1376524363
Provider Name (Legal Business Name): DARBY PHYSICAL THERAPY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 RIVERSIDE DR SUITE 300-A
MACON GA
31210-2550
US

IV. Provider business mailing address

248 TOM HILL SR BLVD #331
MACON GA
31210-1815
US

V. Phone/Fax

Practice location:
  • Phone: 478-471-1004
  • Fax: 478-471-1048
Mailing address:
  • Phone: 478-474-8847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number005662
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number005662
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number005662
License Number StateGA

VIII. Authorized Official

Name: DEBORAH K GILMORE
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 478-471-1004