Healthcare Provider Details

I. General information

NPI: 1790106201
Provider Name (Legal Business Name): FUNCTIONAL ATHLETIC REHABILITATION & MOVEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2013
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 NARROWS PARKWAY SUITE A
BIRMINGHAM AL
35242
US

IV. Provider business mailing address

203 NARROWS PARKWAY SUITE A
BIRMINGHAM AL
35242
US

V. Phone/Fax

Practice location:
  • Phone: 205-419-1595
  • Fax: 205-724-9130
Mailing address:
  • Phone: 205-419-1595
  • Fax: 205-724-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2415
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2415
License Number StateAL

VIII. Authorized Official

Name: DR. BEAU RYAN BEARD
Title or Position: OWNER
Credential: DC, MS, CCSP
Phone: 205-419-1595