Healthcare Provider Details

I. General information

NPI: 1801484746
Provider Name (Legal Business Name): JENNINGS KELSEY MOODY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 CHESNUT BYP STE B
CENTRE AL
35960-2830
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 256-266-1001
  • Fax: 256-266-1071
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-933-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH8587
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: