Healthcare Provider Details

I. General information

NPI: 1699341412
Provider Name (Legal Business Name): P4 PHYSICAL THERAPY LLC-MUSCLE SHOALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 E AVALON AVE STE B
TUSCUMBIA AL
35674-1771
US

IV. Provider business mailing address

8059 MITCHELL LN
VESTAVIA HILLS AL
35216-6821
US

V. Phone/Fax

Practice location:
  • Phone: 205-441-5268
  • Fax:
Mailing address:
  • Phone: 205-607-0632
  • 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: MICHELLE SMITH
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 205-531-4200