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	:	1619466513
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	:	219-365-6560
Fax Number	:	219-365-6561

Provider Business Practice Location Address
First Line	:	7813 SPIVEY STATION BLVD STE 230
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30236-2900
Country	:	US
Telephone Number	:	404-251-2458
Fax Number	:	404-251-2460

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	GREGORY L COOPER
Credential	:
Telephone Number	:	219-365-6560

Provider Enumeration Date	:	05/07/2018
Last Update Date	:	05/08/2018

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