Healthcare Provider Details

I. General information

NPI: 1386821320
Provider Name (Legal Business Name): FOUNDATIONAL PHYSICAL THERAPY & MESSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 PINEHILL DRIVE
MOBILE AL
36606-1735
US

IV. Provider business mailing address

5350 GRAND BAY WILMER RD SOUTH
GRAND BAY AL
36541-5438
US

V. Phone/Fax

Practice location:
  • Phone: 251-458-3570
  • Fax: 251-865-9436
Mailing address:
  • Phone: 251-458-3570
  • Fax: 251-865-9436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2268
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH4Z16
License Number StateAL

VIII. Authorized Official

Name: WENDY KAY WILHELM
Title or Position: OWNER OF LLC
Credential: PT LMT
Phone: 251-458-3570