Healthcare Provider Details

I. General information

NPI: 1649635889
Provider Name (Legal Business Name): CAHABA PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SOUTHLAND DR SUITE 111
VESTAVIA AL
35226-3710
US

IV. Provider business mailing address

500 SOUTHLAND DR SUITE 111
VESTAVIA AL
35226-3710
US

V. Phone/Fax

Practice location:
  • Phone: 205-490-8046
  • Fax: 205-449-4635
Mailing address:
  • Phone: 205-490-8046
  • Fax: 205-449-4635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPTH6103
License Number StateAL

VIII. Authorized Official

Name: RACHEL BUTLER
Title or Position: OWNER
Credential: DPT
Phone: 205-490-8046