Provider Demographics
NPI:1235371295
Name:FCE-PPD CENTER
Entity Type:Organization
Organization Name:FCE-PPD CENTER
Other - Org Name:BLANKENSHIP FCE-PPD CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPS
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:CWCP
Authorized Official - Phone:478-475-9393
Mailing Address - Street 1:3040 RIVERSIDE DR
Mailing Address - Street 2:SUITE C-5
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2521
Mailing Address - Country:US
Mailing Address - Phone:478-475-9393
Mailing Address - Fax:478-475-9353
Practice Address - Street 1:3040 RIVERSIDE DR
Practice Address - Street 2:SUITE C-5
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2521
Practice Address - Country:US
Practice Address - Phone:478-475-9393
Practice Address - Fax:478-475-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0016292251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty