Healthcare Provider Details

I. General information

NPI: 1437750841
Provider Name (Legal Business Name): P4 PHYSICAL THERAPY- BLAINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 07/27/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 RUTLEDGE PIKE
BLAINE TN
37709
US

IV. Provider business mailing address

8059 MITCHELL LN
VESTAVIA HILLS AL
35216-6821
US

V. Phone/Fax

Practice location:
  • Phone: 865-498-6900
  • Fax:
Mailing address:
  • Phone: 205-478-4418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHELLE SMITH
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 205-607-0632