Healthcare Provider Details

I. General information

NPI: 1275753188
Provider Name (Legal Business Name): ANDREA LENISE RELIFORD PT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 HIGHWAY 280 EAST SUITE 105
BIRMINGHAM AL
35242-2833
US

IV. Provider business mailing address

6801 DUBLIN CT SO
BIRMINGHAM AL
35212-1936
US

V. Phone/Fax

Practice location:
  • Phone: 205-408-0700
  • Fax: 205-408-0702
Mailing address:
  • Phone: 205-903-9205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5255
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number805
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: