Healthcare Provider Details

I. General information

NPI: 1497861926
Provider Name (Legal Business Name): IMPACT REHABILITATION AND SPORTS MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CARRINGTON LN STE C
CALERA AL
35040-5439
US

IV. Provider business mailing address

PO BOX 1694
CALERA AL
35040-1694
US

V. Phone/Fax

Practice location:
  • Phone: 205-621-3077
  • Fax: 205-621-3788
Mailing address:
  • Phone: 205-621-3077
  • Fax: 205-621-3788

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: MICHAEL CHADWICK
Title or Position: OWNER
Credential:
Phone: 205-621-3077