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General NPI Number Information
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NPI Number | 1386821320
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Entity Type | Organization
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Legal Business Name | FOUNDATIONAL PHYSICAL THERAPY & MESSAGE
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 319 PINEHILL DRIVE
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City | MOBILE
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State | AL
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Zip | 36606-1735
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Country | US
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Telephone | 251-458-3570
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Fax | 251-865-9436
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Provider Business Mailing Address
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Address Line | 5350 GRAND BAY WILMER RD SOUTH
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City | GRAND BAY
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State | AL
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Zip | 36541-5438
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Country | US
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Telephone | 251-458-3570
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Fax | 251-865-9436
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Authorized Official
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Title or Position | OWNER OF LLC
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Name | WENDY KAY WILHELM
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Credential | PT LMT
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Telephone | 251-458-3570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 2268
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTH4Z16
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License Number State | AL
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