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General NPI Number Information
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NPI Number | 1043362734
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Entity Type | Organization
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Legal Business Name | PHYSICAL EXPRESS
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 4081 ALABAMA HWY 14
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City | MILLBROOK
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State | AL
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Zip | 36054
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Country | US
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Telephone | 334-285-3222
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Fax | 334-285-6555
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Provider Business Mailing Address
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Address Line | PO BOX 688
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City | MILLBROOK
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State | AL
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Zip | 36054-0014
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Country | US
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Telephone | 334-285-3222
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Fax | 334-285-6555
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MRS. JADE LANE
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Credential |
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Telephone | 334-567-4311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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