1376865428 NPI number — THERAPY UNLIMITED, INC

Table of content: GEORGE OLUWABORO (NPI 1235776345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376865428 NPI number — THERAPY UNLIMITED, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPY UNLIMITED, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376865428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 MICAH WAY
Provider Second Line Business Mailing Address:
SUITE 1105
Provider Business Mailing Address City Name:
SCOTTSBORO
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35769-4161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-259-4440
Provider Business Mailing Address Fax Number:
256-259-4462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 MICAH WAY STE 1105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSBORO
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35769-4161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-259-4440
Provider Business Practice Location Address Fax Number:
256-259-4462
Provider Enumeration Date:
02/17/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CLEMONS
Authorized Official First Name:
BRANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
256-259-4440

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)