Healthcare Provider Details

I. General information

NPI: 1801994249
Provider Name (Legal Business Name): PEDIATRIC PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 OLD SHELL RD
MOBILE AL
36607-2505
US

IV. Provider business mailing address

3202 OLD SHELL RD
MOBILE AL
36607-2505
US

V. Phone/Fax

Practice location:
  • Phone: 251-450-0070
  • Fax: 251-450-0072
Mailing address:
  • Phone: 251-450-0070
  • Fax: 251-450-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTH2831
License Number StateAL

VIII. Authorized Official

Name: CHERYL LAMBERT THAMES
Title or Position: OWNER
Credential: PT
Phone: 251-450-0070