Healthcare Provider Details

I. General information

NPI: 1104012087
Provider Name (Legal Business Name): CONCENTRA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 4TH AVE S
BIRMINGHAM AL
35233-2521
US

IV. Provider business mailing address

2500 4TH AVE S
BIRMINGHAM AL
35233-2521
US

V. Phone/Fax

Practice location:
  • Phone: 205-263-5800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2021
License Number StateAL

VIII. Authorized Official

Name: LEESA MILES
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 205-263-5800