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General NPI Number Information
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NPI Number | 1922443225
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Entity Type | Organization
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Legal Business Name | NEO PT INC.
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 507 S 4TH ST
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City | GADSDEN
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State | AL
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Zip | 35901-5216
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Country | US
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Telephone | 256-456-0563
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Fax |
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Provider Business Mailing Address
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Address Line | 507 S 4TH ST
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City | GADSDEN
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State | AL
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Zip | 35901-5216
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Country | US
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Telephone | 256-456-0563
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. CHRISTOPHER SHANE RUSSELL
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Credential | A.T.C.
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Telephone | 256-456-0563
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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 | PTH 3100
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License Number State | AL
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