Healthcare Provider Details

I. General information

NPI: 1659034759
Provider Name (Legal Business Name): FYZICAL MERIDIAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 26TH AVE
MERIDIAN MS
39305-4706
US

IV. Provider business mailing address

101 US HIGHWAY 80 W
DEMOPOLIS AL
36732-4101
US

V. Phone/Fax

Practice location:
  • Phone: 334-289-5696
  • Fax: 334-289-5578
Mailing address:
  • Phone: 334-289-5696
  • Fax: 334-289-5578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGIE SOLLIDAY
Title or Position: BILLING ADMIN
Credential:
Phone: 334-289-5696