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General NPI Number Information
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NPI Number | 1477647816
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Entity Type | Organization
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Legal Business Name | DOTHAN THERAPY ASSOCIATES INC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 3118 ROSS CLARK CIRCLE
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City | DOTHAN
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State | AL
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Zip | 36303
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Country | US
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Telephone | 334-673-2422
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Fax | 334-673-2425
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Provider Business Mailing Address
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Address Line | 3118 ROSS CLARK CIRCLE
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City | DOTHAN
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State | AL
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Zip | 36303
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Country | US
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Telephone | 334-673-2422
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Fax | 334-673-2425
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES OUTLAW
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Credential | PT
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Telephone | 334-673-2422
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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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