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General NPI Number Information
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NPI Number | 1407224728
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Entity Type | Organization
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Legal Business Name | LYSTRA PHYSICAL THERAPY AND WELLNESS, LLC
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 8331 MADISON BLVD
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City | MADISON
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State | AL
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Zip | 35758-2068
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Country | US
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Telephone | 256-325-2070
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Fax | 844-587-9612
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Provider Business Mailing Address
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Address Line | 8331 MADISON BLVD SUITE 500
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City | MADISON
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State | AL
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Zip | 35758-2068
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Country | US
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Telephone | 256-325-2070
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Fax | 844-587-9612
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Authorized Official
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Title or Position | PT
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Name | MR. ROBERT MALONE
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Credential | PT
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Telephone | 256-325-2070
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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 | PTH4294
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License Number State | AL
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