Healthcare Provider Details

I. General information

NPI: 1154450153
Provider Name (Legal Business Name): INDUSTRIAL WELLNESS REHAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7965 MOFFETT RD
SEMMES AL
36575-5409
US

IV. Provider business mailing address

2048 S BROAD ST # A BROOKLEY COMPLEX
MOBILE AL
36615-1285
US

V. Phone/Fax

Practice location:
  • Phone: 251-645-3708
  • Fax: 251-645-5837
Mailing address:
  • Phone: 251-433-1414
  • Fax: 251-433-9634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH4083
License Number StateAL

VIII. Authorized Official

Name: MRS. LISA W SULLIVAN
Title or Position: VP- ACCTS RECEIVABLE MANAGER
Credential:
Phone: 251-433-1414