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General NPI Number Information
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NPI Number | 1154578524
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Entity Type | Organization
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Legal Business Name | AGILE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 3125 BLUE LAKE DR
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City | VESTAVIA
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State | AL
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Zip | 35243-2333
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Country | US
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Telephone | 205-969-7887
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Fax | 205-969-7886
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Provider Business Mailing Address
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Address Line | 3125 BLUE LAKE DR
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City | VESTAVIA
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State | AL
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Zip | 35243-2333
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Country | US
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Telephone | 205-969-7887
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Fax | 205-969-7886
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. LISA CATES ALTAMIRANO
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Credential | PT MS CSCS
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Telephone | 205-969-7887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PTH3294
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License Number State | AL
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