Healthcare Provider Details

I. General information

NPI: 1043611270
Provider Name (Legal Business Name): JOHN FLETCHER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3078 DAUPHIN SQ CONNECTOR
MOBILE AL
36607-2500
US

IV. Provider business mailing address

251 JOHNSTON SEST 200
DECATUR AL
35601-2515
US

V. Phone/Fax

Practice location:
  • Phone: 251-341-5662
  • Fax: 256-341-5663
Mailing address:
  • Phone: 228-388-5714
  • Fax: 228-388-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH7263
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: