Healthcare Provider Details

I. General information

NPI: 1881841419
Provider Name (Legal Business Name): VIRGINIA LEIGH CHILDRESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 US HWY 90 SERVICE RD
MOBILE AL
36619
US

IV. Provider business mailing address

PO BOX 92
MOBILE AL
36601-0092
US

V. Phone/Fax

Practice location:
  • Phone: 251-445-7912
  • Fax: 251-431-5810
Mailing address:
  • Phone: 251-445-7912
  • Fax: 251-431-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24040
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: