1801065537 NPI number — PHYSICAL THERAPY OF ANDALUSIA

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 1801065537 NPI number — PHYSICAL THERAPY OF ANDALUSIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY OF ANDALUSIA
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:
6
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:
1801065537
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1105 W BYPASS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDALUSIA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36420-5255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-222-5785
Provider Business Mailing Address Fax Number:
334-222-8062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1105 W BYPASS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDALUSIA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36420-5255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-222-5785
Provider Business Practice Location Address Fax Number:
334-222-0181
Provider Enumeration Date:
02/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RIDER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
334-222-5785

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PTH551 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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