Mary Grace Ricio Pancho, RPT

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PT013185 Issued in GA

Practice address

350 Hospital Dr
Macon, GA 31217-3838

Phone

(478) 765-7000

NPI assigned

Jan 12, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1673481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1003520156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 LASSO DR",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310886646",
            "telephone_number": "706-459-4184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 HOSPITAL DR",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312173838",
            "telephone_number": "478-765-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANCHO",
        "first_name": "MARY GRACE",
        "middle_name": "RICIO",
        "credential": "RPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-12",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "GA",
            "license": "PT013185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Daniel Paisible Jr., M.D.
• Palmetto Medical Services Inc
• Palmyra Surgical, LLC
• Palmyra Surgical, LLC
• Pamela Onderko DPM LLC
• Ohm Pandya, DO
• Sagar Jayant Panse, M.D.
• Bhavesh Papadi, MD
• Robert Jack Parel II, M.D.
• Deborah Parfittmerritt

• Physical Therapy Clinic/Center in Macon, GA
• Providers in Macon, GA by specialty
• Physical Therapy Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.