Healthcare Provider Details

I. General information

NPI: 1619979283
Provider Name (Legal Business Name): PHYSICAL THERAPY SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12831 6TH ST SUITES C AND D
LILLIAN AL
36549-4166
US

IV. Provider business mailing address

12831 6TH ST SUITES C AND D
LILLIAN AL
36549-4166
US

V. Phone/Fax

Practice location:
  • Phone: 251-962-2149
  • Fax: 251-961-3815
Mailing address:
  • Phone: 251-962-2149
  • Fax: 251-961-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH3908
License Number StateAL

VIII. Authorized Official

Name: DR. MICHAEL RODGER LAND
Title or Position: OWNER
Credential: D.P.T.
Phone: 251-962-2149