Active NPI
Michael R Wisdom, PT
- Physical Therapist
- Macon, GA
National Provider Identifier
1578579686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT000867
- Practice address
- 630 Orange St
Wisdom Physical Therapy
Macon, GA 31201 - Phone
- (478) 746-5469
- Fax
- (478) 750-7841
- NPI assigned
- Jul 31, 2006
- Last updated
- Sep 29, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT000867 | GA | Primary |
Addresses
Primary practice location
630 Orange St
Wisdom Physical Therapy
Macon, GA 31201
Mailing address
630 Orange St
Wisdom Physical Therapy
Macon, GA 31201
Phone (478) 746-5469
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 58172018531201A001 | Other | GA | TRICARE |
| 980154 | Other | GA | BCBS |
| 354809 | Other | GA | WELLCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT000867 | GA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michael R Wisdom PT Physical Therapy Inc | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Wisdom Physical Therapy
- Physical Therapist
- Macon, GA
- NPI 1467466367
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790640000000",
"number": "1578579686",
"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 ST",
"address_2": "WISDOM PHYSICAL THERAPY",
"city": "MACON",
"state": "GA",
"postal_code": "31201",
"telephone_number": "478-746-5469",
"fax_number": "478-750-7841"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISDOM",
"first_name": "MICHAEL",
"middle_name": "R",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2026-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT000867",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "58172018531201A001",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "980154",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "354809",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.