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NPI Code Detail

MEDICARE: CORE PHYSICAL THERAPY, PC

MEDICARE: CORE PHYSICAL THERAPY, PC
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
1261QP2000XPhysical Therapy Clinic/Center005265GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3GRP7944OTHERMEDICARE GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11639353261OTHERDANNIELLE PUCKETT NPI
21699777367OTHERANGEL BROWN NPI
41619044906OTHERKEITH BROWN NPI

General Provider Information

NPI Number : 1982763744
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORE PHYSICAL THERAPY, PC
Provider Business Mailing Address
First Line : 301 MARGIE DR
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31088-7818
Country : US
Telephone Number : 478-953-5800
Fax Number : 478-953-5855
Provider Business Practice Location Address
First Line : 301 MARGIE DR
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31088-7818
Country : US
Telephone Number : 478-953-5800
Fax Number : 478-953-5855
Authorized Official
Title or Position : PRESIDENT
Name : MR. KEITH BROWN
Credential : P.T.
Telephone Number : 478-953-5800
Provider Enumeration Date : 12/07/2006
Last Update Date : 02/11/2008

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Practice Location Address:
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1578679833 — MELISSA BENTLEY P.T.
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Directions to “CORE PHYSICAL THERAPY, PC ” Practice Location

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