MEDICARE: MADISON PHYSICAL THERAPY P.C.

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	:	1881549889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADISON PHYSICAL THERAPY P.C.

Provider Business Mailing Address
First Line	:	2525 BRIDLEWOOD LN SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-1975
Country	:	US
Telephone Number	:	770-335-5551
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 BRIDLEWOOD LN SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-1975
Country	:	US
Telephone Number	:	770-335-5551
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LEOPOLD BINN KIM
Credential	:	PT
Telephone Number	:	770-335-5551

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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