Healthcare Provider Details

I. General information

NPI: 1982951026
Provider Name (Legal Business Name): NORTHRIVER THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 MCFARLAND BLVD
NORTHPORT AL
35476-3326
US

IV. Provider business mailing address

212 MCFARLAND BLVD
NORTHPORT AL
35476-3326
US

V. Phone/Fax

Practice location:
  • Phone: 205-292-3266
  • Fax:
Mailing address:
  • Phone: 205-333-5351
  • Fax: 205-333-5345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPTH3433
License Number StateAL

VIII. Authorized Official

Name: TODD GIBBONS MILLER
Title or Position: OWNER
Credential: PT
Phone: 205-292-3266