MEDICARE: EMORY PHYSICAL THERAPY, LLC

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

General Provider Information

NPI Number	:	1124959051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMORY PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	8259 WICKER AVE
Second Line	:
City	:	SAINT JOHN
State	:	IN
Zip	:	46373-8878
Country	:	US
Telephone Number	:	740-275-4480
Fax Number	:

Provider Business Practice Location Address
First Line	:	3051 WATSON BLVD STE 525
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-8556
Country	:	US
Telephone Number	:	478-953-4563
Fax Number	:	478-971-2204

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL/MANAGING EMPLOY
Name	:	GREGORY L COOPER
Credential	:
Telephone Number	:	219-365-6560

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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