Healthcare Provider Details

I. General information

NPI: 1073452983
Provider Name (Legal Business Name): SUSTAINING GRACE PHYSIOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23769 CONIFER CT
ORANGE BEACH AL
36561-5228
US

IV. Provider business mailing address

23769 CONIFER CT
ORANGE BEACH AL
36561-5228
US

V. Phone/Fax

Practice location:
  • Phone: 225-931-4718
  • Fax:
Mailing address:
  • Phone: 225-931-4718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LESLIE NIEDERRITER
Title or Position: OWNER
Credential: PT, DPT
Phone: 225-931-4718