1215995659 NPI number — SUNSHINE RESOURCES

Table of content: (NPI 1215995659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215995659 NPI number — SUNSHINE RESOURCES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNSHINE RESOURCES
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:
DARBY PHYSICAL THERAPY ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1215995659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
248 TOM HILL SR BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31210-1815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
147-847-1004
Provider Business Mailing Address Fax Number:
478-471-1048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 RIVERSIDE DR
Provider Second Line Business Practice Location Address:
SUITE 300-A
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31210-2550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-471-1004
Provider Business Practice Location Address Fax Number:
478-471-1048
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COCHRAN
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
478-471-1004

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT002457 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225100000X , with the licence number: PT007723 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225100000X , with the licence number: PT004371 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225X00000X , with the licence number: OT002545 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 235Z00000X , with the licence number: SLP005800 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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