Healthcare Provider Details

I. General information

NPI: 1699910505
Provider Name (Legal Business Name): THERAPY SOUTH MOUNTAIN BROOK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 COUNTRY CLUB PARK
BIRMINGHAM AL
35213-4237
US

IV. Provider business mailing address

2823 GREYSTONE COMMERCIAL BLVD
BIRMINGHAM AL
35242-2660
US

V. Phone/Fax

Practice location:
  • Phone: 205-822-7607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HANNAH KELLY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 205-745-3660