Healthcare Provider Details

I. General information

NPI: 1780111344
Provider Name (Legal Business Name): FYZICAL THERAPY OF TUSCALOOSA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MCFARLAND BLVD NE STE 150
TUSCALOOSA AL
35406-2283
US

IV. Provider business mailing address

1300 MCFARLAND BLVD NE STE 150
TUSCALOOSA AL
35406-2283
US

V. Phone/Fax

Practice location:
  • Phone: 205-758-9041
  • Fax: 205-345-8328
Mailing address:
  • Phone: 205-758-9041
  • Fax: 205-345-8328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JERRI THWEATT
Title or Position: PRACTICE MANAGER
Credential:
Phone: 205-758-9041