1902836745 NPI number — PHYSICAL THERAPY OF PHENIX CITY, PC

Table of content: (NPI 1902836745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902836745 NPI number — PHYSICAL THERAPY OF PHENIX CITY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY OF PHENIX CITY, PC
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:
1902836745
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6270A N UCHEE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HATCHECHUBBEE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36858-2808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-448-3900
Provider Business Mailing Address Fax Number:
334-298-6086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1321 9TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHENIX CITY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36867-5027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-448-2641
Provider Business Practice Location Address Fax Number:
334-298-6086
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GODBEY
Authorized Official First Name:
MARIA FE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO, PHYSICAL THERAPIST
Authorized Official Telephone Number:
334-448-3900

Provider Taxonomy Codes

  • Taxonomy code: 2251E1300X , with the licence number:  17304 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251N0400X , with the licence number: PTH3832 , 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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