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General NPI Number Information
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NPI Number | 1477859601
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Entity Type | Organization
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Legal Business Name | MANDEVILLE PHYSICAL THERAPY & WELLNESS, INC
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Dates
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Enumeration Date | 02/05/2011
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 8300 WHITESBURG DR SE SUITE A
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City | HUNTSVILLE
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State | AL
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Zip | 35802-3008
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Country | US
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Telephone | 256-679-6642
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Fax | 256-883-1533
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Provider Business Mailing Address
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Address Line | 8300 WHITESBURG DR SW STE A
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City | HUNTSVILLE
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State | AL
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Zip | 35802-3064
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Country | US
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Telephone | 256-679-6642
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Fax | 256-270-9923
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Authorized Official
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Title or Position | OWNER
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Name | MATT MANDEVILLE
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Credential | PT
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Telephone | 256-679-6641
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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 | PTH3087
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License Number State | AL
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