MEDICARE: CAPACITYLAB 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
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	621340	OTHER	AL	NAICS

General Provider Information

NPI Number	:	1245837335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPACITYLAB LLC

Provider Business Mailing Address
First Line	:	450A CENTURY PARK S STE 104
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35226-3910
Country	:	US
Telephone Number	:	205-305-5311
Fax Number	:

Provider Business Practice Location Address
First Line	:	450A CENTURY PARK S STE 104
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35226-3910
Country	:	US
Telephone Number	:	205-305-5311
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAURA PATTON
Credential	:	PT, DPT
Telephone Number	:	205-305-5311

Provider Enumeration Date	:	10/02/2020
Last Update Date	:	10/02/2020

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Directions to “CAPACITYLAB LLC ” Practice Location

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