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Organization
MICHAEL R WISDOM PT PHYSICAL THERAPY INC
Active
Organization
MICHAEL R WISDOM PT PHYSICAL THERAPY INC
Active
Other names
Wisdom Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL RAY WISDOM PT (PRES)
(478) 746-5469
Entity
Organization
Contact information
Practice address
630 ORANGE S, WISDOM PHYSICAL THERAPY, MACON, GA 31201
(478) 746-5469
(478) 750-7841
Mailing address
630 ORANGE ST, WISDOM PHYSICAL THERAPY, MACON, GA 31201
(478) 746-5469
(478) 750-7841
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT000867
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
980154
BLUE CROSS BLUE SHIELD
GA
Enumeration date
07/28/2006
Last updated
08/22/2020
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