Healthcare Provider Details

I. General information

NPI: 1386486769
Provider Name (Legal Business Name): PTP LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 MAIN AVE SW
CULLMAN AL
35055-3348
US

IV. Provider business mailing address

1716 MEADOWBROOK DR SE
CULLMAN AL
35055-9563
US

V. Phone/Fax

Practice location:
  • Phone: 256-708-0329
  • Fax: 205-543-6910
Mailing address:
  • Phone: 256-708-0329
  • Fax: 205-543-6910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. COURTNEY GREEN
Title or Position: OWNER/DIRECTOR OF PHYSICAL THERAPY
Credential: DPT
Phone: 256-708-0329