Healthcare Provider Details

I. General information

NPI: 1942308689
Provider Name (Legal Business Name): CANCER REHAB & EDEMA SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 AIRPORT BLVD STE 310
MOBILE AL
36608-3181
US

IV. Provider business mailing address

4715 AIRPORT BLVD STE 310
MOBILE AL
36608-3181
US

V. Phone/Fax

Practice location:
  • Phone: 251-344-4212
  • Fax: 251-344-4302
Mailing address:
  • Phone: 251-344-4212
  • Fax: 251-344-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEBRA TAYLOR
Title or Position: OWNER
Credential: P.T.
Phone: 251-344-4212