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General NPI Number Information
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NPI Number | 1154450153
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Entity Type | Organization
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Legal Business Name | INDUSTRIAL WELLNESS REHAB, INC.
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 7965 MOFFETT RD
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City | SEMMES
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State | AL
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Zip | 36575-5409
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Country | US
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Telephone | 251-645-3708
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Fax | 251-645-5837
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Provider Business Mailing Address
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Address Line | 2048 S BROAD ST # A BROOKLEY COMPLEX
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City | MOBILE
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State | AL
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Zip | 36615-1285
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Country | US
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Telephone | 251-433-1414
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Fax | 251-433-9634
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Authorized Official
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Title or Position | VP- ACCTS RECEIVABLE MANAGER
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Name | MRS. LISA W SULLIVAN
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Credential |
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Telephone | 251-433-1414
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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 | PTH4083
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License Number State | AL
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