Healthcare Provider Details

I. General information

NPI: 1881673390
Provider Name (Legal Business Name): SUMMER MIMS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1792 MCFARLAND BLVD N SUITE B
TUSCALOOSA AL
35406-2185
US

IV. Provider business mailing address

1792 MCFARLAND BLVD N SUITE B
TUSCALOOSA AL
35406-2185
US

V. Phone/Fax

Practice location:
  • Phone: 205-342-2546
  • Fax: 205-342-2540
Mailing address:
  • Phone: 205-342-2546
  • Fax: 205-342-2540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA3671
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: