Healthcare Provider Details

I. General information

NPI: 1235092628
Provider Name (Legal Business Name): BAY MINETTE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 S US HIGHWAY 31
BAY MINETTE AL
36507-2611
US

IV. Provider business mailing address

1512 S US HIGHWAY 31
BAY MINETTE AL
36507-2611
US

V. Phone/Fax

Practice location:
  • Phone: 251-580-3232
  • Fax: 251-580-3234
Mailing address:
  • Phone: 251-580-3232
  • Fax: 251-580-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PAMELA P VAN ETTEN
Title or Position: DIR OF CREDENTIALING AND ACC PAYABL
Credential:
Phone: 334-799-5853