Healthcare Provider Details

I. General information

NPI: 1669001269
Provider Name (Legal Business Name): P4 PHYSICAL THERAPY - JONES VALLEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7242 BAILEY COVE RD SE
HUNTSVILLE AL
35802-2746
US

IV. Provider business mailing address

8059 MITCHELL LN
VESTAVIA HILLS AL
35216-6821
US

V. Phone/Fax

Practice location:
  • Phone: 205-478-4418
  • Fax:
Mailing address:
  • Phone: 205-478-4418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DONALD LEA SMITH JR.
Title or Position: PRACTICE MANAGER
Credential: DPT
Phone: 205-478-4418