Healthcare Provider Details

I. General information

NPI: 1548044712
Provider Name (Legal Business Name): VULCAN PERFORMANCE MOUNTAIN BROOK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3918 MONTCLAIR RD STE 101
MOUNTAIN BRK AL
35213-2417
US

IV. Provider business mailing address

3918 MONTCLAIR RD STE 101
MOUNTAIN BRK AL
35213-2417
US

V. Phone/Fax

Practice location:
  • Phone: 205-761-1068
  • Fax: 205-719-4158
Mailing address:
  • Phone: 205-761-1068
  • Fax: 205-719-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SEAN ALLEN HILLER
Title or Position: BUSINESS OWNER, CEO
Credential: DPT
Phone: 205-761-1068