Healthcare Provider Details

I. General information

NPI: 1396096665
Provider Name (Legal Business Name): ALABAMA PAIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WHITESPORT CIR SW
HUNTSVILLE AL
35801-6495
US

IV. Provider business mailing address

600 WHITESPORT CIR SW
HUNTSVILLE AL
35801-6495
US

V. Phone/Fax

Practice location:
  • Phone: 256-882-2003
  • Fax: 256-705-4630
Mailing address:
  • Phone: 256-882-2003
  • Fax: 256-705-4630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH6588
License Number StateAL

VIII. Authorized Official

Name: MRS. LASONYA NIX
Title or Position: BILLING DORECTOR
Credential: CPC
Phone: 256-882-2003