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General NPI Number Information
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NPI Number | 1134784689
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Entity Type | Organization
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Legal Business Name | THERAPY SOUTH - GLUCKSTADT LLC
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Dates
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Enumeration Date | 05/09/2019
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 1716 US 51 STE N
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City | MADISON
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State | MS
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Zip | 39110
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Country | US
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Telephone | 601-499-5780
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Fax |
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Provider Business Mailing Address
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Address Line | 2823 GREYSTONE COMMERCIAL BLVD
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City | BIRMINGHAM
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State | AL
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Zip | 35242-2660
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Country | US
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Telephone | 205-745-3660
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | HANNAH KELLY
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Credential |
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Telephone | 205-745-3660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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