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NPI Code Detail

MEDICARE: THERAPY SOUTH GADSDEN LLC

MEDICARE: THERAPY SOUTH GADSDEN LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12564391550OTHERALPHONE NUMBER

General Provider Information

NPI Number : 1215597919
Entity Type Code : Organization
Provider Name (Legal Business Name) : THERAPY SOUTH GADSDEN LLC
Provider Business Mailing Address
First Line : 2823 GREYSTONE COMMERCIAL BLVD
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35242-2660
Country : US
Telephone Number : 205-745-3660
Fax Number :
Provider Business Practice Location Address
First Line : 465 GEORGE WALLACE DR
Second Line :
City : GADSDEN
State : AL
Zip : 35903-2282
Country : US
Telephone Number : 256-439-1550
Fax Number : 256-439-1551
Authorized Official
Title or Position : CREDENTIALING SPECIALIST
Name : HANNAH KELLY
Credential :
Telephone Number : 205-745-3660
Provider Enumeration Date : 06/17/2019
Last Update Date : 07/29/2020

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Directions to “THERAPY SOUTH GADSDEN LLC ” Practice Location

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