Michael R Wisdom PT Physical Therapy Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT000867 Issued in GA

Legal business name

MICHAEL R WISDOM PT PHYSICAL THERAPY INC

Practice address

630 Orange S
Wisdom Physical Therapy
Macon, GA 31201

Phone

(478) 746-5469

Fax

(478) 750-7841

NPI assigned

Jul 28, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Michael Ray Wisdom, PTNPI 1578579686

Title

Pres

Phone

(478) 746-5469

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wisdom Physical Therapy Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael R Wisdom, PT

  • Physical Therapist
  • Macon, GA
  • NPI 1578579686
  NPD (past) Authorized official

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467466367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 ORANGE ST",
            "address_2": "WISDOM PHYSICAL THERAPY",
            "city": "MACON",
            "state": "GA",
            "postal_code": "31201",
            "telephone_number": "478-746-5469",
            "fax_number": "478-750-7841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 ORANGE S",
            "address_2": "WISDOM PHYSICAL THERAPY",
            "city": "MACON",
            "state": "GA",
            "postal_code": "31201",
            "telephone_number": "478-746-5469",
            "fax_number": "478-750-7841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL R WISDOM PT PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WISDOM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "478-746-5469",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT000867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "980154",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wisdom Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephen Richard Meyers
• MFP Medical Services, LLC
• Mgas Holdings, LLC
• Michael E. Greene MD, LLC
• Michael R Johns PSYD
• Elizabeth Jane Michael, MD
• Garry Michael, NP-C
• Jesse Michael, AA-C
• Nicholas P Michalakis, DO
• Brittany Mickey

• Physical Therapist in Macon, GA
• Providers in Macon, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.