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General NPI Number Information
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NPI Number | 1235371295
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Entity Type | Organization
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Legal Business Name | FCE-PPD CENTER
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Dates
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Enumeration Date | 04/06/2009
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Last Update Date | 04/06/2009
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Provider Practice Location Address
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Address Line | 3040 RIVERSIDE DR SUITE C-5
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City | MACON
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State | GA
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Zip | 31210-2521
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Country | US
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Telephone | 478-475-9393
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Fax | 478-475-9353
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Provider Business Mailing Address
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Address Line | 3040 RIVERSIDE DR SUITE C-5
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City | MACON
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State | GA
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Zip | 31210-2521
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Country | US
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Telephone | 478-475-9393
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Fax | 478-475-9353
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Authorized Official
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Title or Position | DIRECTOR OF BUSINESS OPS
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Name | LISA S BLANKENSHIP
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Credential | CWCP
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Telephone | 478-475-9393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT001629
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License Number State | GA
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