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General NPI Number Information
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NPI Number | 1063825412
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Entity Type | Organization
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Legal Business Name | STRONG STANCE ORTHOTICS & FITNESS
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 1529 BESSEMER RD
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City | BIRMINGHAM
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State | AL
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Zip | 35208-4016
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Country | US
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Telephone | 205-249-9793
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Fax |
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Provider Business Mailing Address
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Address Line | 495 HEATHERWOOD DR
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City | HOOVER
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State | AL
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Zip | 35244-3221
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Country | US
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Telephone | 205-249-9793
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DEDRICK LANARD AGEE
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Credential |
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Telephone | 205-249-9793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 583
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License Number State | AL
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