MEDICARE: RIVER CITY PHYSICAL THERAPY

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	225100000X	Physical Therapist	PT006199	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DA5511	OTHER	GA	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1104834902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER CITY PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	2616 WARM SPRINGS RD
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5323
Country	:	US
Telephone Number	:	706-243-0016
Fax Number	:	706-243-0019

Provider Business Practice Location Address
First Line	:	2616 WARM SPRINGS RD
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5323
Country	:	US
Telephone Number	:	706-243-0016
Fax Number	:	706-243-0019

Authorized Official
Title or Position	:	REGIONAL MANAGER
Name	:	MEGAN MCDONALD
Credential	:	MSPT
Telephone Number	:	404-236-0808

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	06/09/2008

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Directions to “RIVER CITY PHYSICAL THERAPY ” Practice Location

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