Healthcare Provider Details

I. General information

NPI: 1649882705
Provider Name (Legal Business Name): P4 PHYSICAL THERAPY - FAYETTEVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 HUNTSVILLE HWY STE B
FAYETTEVILLE TN
37334-3685
US

IV. Provider business mailing address

8059 MITCHELL LN
VESTAVIA HILLS AL
35216-6821
US

V. Phone/Fax

Practice location:
  • Phone: 205-999-4622
  • Fax:
Mailing address:
  • Phone: 205-999-4622
  • Fax: 205-999-4622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DONALD L SMITH
Title or Position: MANAGING PARTNER
Credential: PT
Phone: 205-478-4418