Healthcare Provider Details

I. General information

NPI: 1073285342
Provider Name (Legal Business Name): NOVA PHYSICAL THERAPY AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 2ND AVE S STE E
BIRMINGHAM AL
35233-2840
US

IV. Provider business mailing address

4312 5TH AVE S
BIRMINGHAM AL
35222-2807
US

V. Phone/Fax

Practice location:
  • Phone: 205-228-9575
  • Fax:
Mailing address:
  • Phone: 205-228-9575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LAURA ELIZABETH RICHARDSON
Title or Position: OWNER
Credential: DPT
Phone: 205-228-9575