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General NPI Number Information
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NPI Number | 1932575057
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Entity Type | Organization
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Legal Business Name | PHYSIOWORKS, SPORTS AND WELLNESS, INC
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 2743 BOB WALLACE AVE SW
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City | HUNTSVILLE
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State | AL
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Zip | 35805-4103
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Country | US
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Telephone | 256-529-7395
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 814
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City | MADISON
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State | AL
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Zip | 35758-0814
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Country | US
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Telephone | 256-424-5192
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ANDREW WALKER
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Credential |
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Telephone | 256-529-7395
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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 | PTH5627
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License Number State | AL
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