1346424769 NPI number — THERAPY SOUTH LLC FULTONDALE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346424769 NPI number — THERAPY SOUTH LLC FULTONDALE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPY SOUTH LLC FULTONDALE
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:
1346424769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2807 GREYSTONE COMMERCIAL BLVD
Provider Second Line Business Mailing Address:
SUITE 34
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242-9600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-745-3660
Provider Business Mailing Address Fax Number:
205-408-4209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3471 LOWERY PKWY
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
FULTONDALE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35068-1680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-849-6566
Provider Business Practice Location Address Fax Number:
205-849-6563
Provider Enumeration Date:
12/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAYES
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR ENROLLMENT
Authorized Official Telephone Number:
205-745-3651

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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