MEDICARE: BARNES ORTHOPEDIC, SPORT, AND SPINE 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	2251X0800X	Orthopedic Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT015025	OTHER	GA	GEORGIA STATE BOARD OF PT

General Provider Information

NPI Number	:	1407446602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARNES ORTHOPEDIC, SPORT, AND SPINE PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	3994 HIGHWAY 42
Second Line	:
City	:	LOCUST GROVE
State	:	GA
Zip	:	30248-4104
Country	:	US
Telephone Number	:	470-507-4607
Fax Number	:	470-507-4608

Provider Business Practice Location Address
First Line	:	3994 HIGHWAY 42
Second Line	:
City	:	LOCUST GROVE
State	:	GA
Zip	:	30248-4104
Country	:	US
Telephone Number	:	470-507-4607
Fax Number	:	470-507-4608

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MR. MICHAEL STEVEN BARNES
Credential	:	PT, MPT, OCS
Telephone Number	:	470-255-9325

Provider Enumeration Date	:	01/21/2021
Last Update Date	:	03/23/2021

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Directions to “BARNES ORTHOPEDIC, SPORT, AND SPINE PHYSICAL THERAPY LLC ” Practice Location

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