1386821320 NPI number — FOUNDATIONAL PHYSICAL THERAPY & MESSAGE

Table of content: (NPI 1386821320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386821320 NPI number — FOUNDATIONAL PHYSICAL THERAPY & MESSAGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOUNDATIONAL PHYSICAL THERAPY & MESSAGE
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:
1386821320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5350 GRAND BAY WILMER RD SOUTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND BAY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36541-5438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-458-3570
Provider Business Mailing Address Fax Number:
251-865-9436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 PINEHILL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36606-1735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-458-3570
Provider Business Practice Location Address Fax Number:
251-865-9436
Provider Enumeration Date:
01/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WILHELM
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
OWNER OF LLC
Authorized Official Telephone Number:
251-458-3570

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PTH4Z16 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225700000X , with the licence number: 2268 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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