Healthcare Provider Details

I. General information

NPI: 1518339001
Provider Name (Legal Business Name): SPECIALIZED THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8720 RAND AVE
DAPHNE AL
36526-9102
US

IV. Provider business mailing address

2200 US HIGHWAY 98 STE 4 #320
DAPHNE AL
36526-4382
US

V. Phone/Fax

Practice location:
  • Phone: 251-990-9082
  • Fax: 251-990-3707
Mailing address:
  • Phone: 251-990-9082
  • Fax: 251-990-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH-3828
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPTH-3828
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTH-3828
License Number StateAL

VIII. Authorized Official

Name: MRS. JILL VAN CAMP LOTT
Title or Position: OWNER / PRESIDENT
Credential: MPT, PRPC, BCB-PMD
Phone: 251-990-9082