Healthcare Provider Details

I. General information

NPI: 1124959051
Provider Name (Legal Business Name): EMORY PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 WATSON BLVD STE 525
WARNER ROBINS GA
31093-8556
US

IV. Provider business mailing address

8259 WICKER AVE
SAINT JOHN IN
46373-8878
US

V. Phone/Fax

Practice location:
  • Phone: 478-953-4563
  • Fax: 478-971-2204
Mailing address:
  • Phone: 740-275-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREGORY L COOPER
Title or Position: AUTHORIZED OFFICIAL/MANAGING EMPLOY
Credential:
Phone: 219-365-6560