MEDICARE: RIVER REGION PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	PTH4014	AL

General Provider Information

NPI Number	:	1174012421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER REGION PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	266 INTERSTATE COMMERCIAL PARK LOOP
Second Line	:
City	:	PRATTVILLE
State	:	AL
Zip	:	36066-7361
Country	:	US
Telephone Number	:	334-568-2121
Fax Number	:	334-568-2124

Provider Business Practice Location Address
First Line	:	266 INTERSTATE COMMERCIAL PARK LOOP
Second Line	:
City	:	PRATTVILLE
State	:	AL
Zip	:	36066-7361
Country	:	US
Telephone Number	:	334-568-2121
Fax Number	:	334-568-2124

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/OWNER
Name	:	LISA OSWALD
Credential	:	PT
Telephone Number	:	334-568-2121

Provider Enumeration Date	:	05/02/2018
Last Update Date	:	08/10/2023

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