MEDICARE: BAY MINETTE PHYSICAL THERAPY SERVICES

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	225100000X	Physical Therapist	PTH1417	AL

General Provider Information

NPI Number	:	1205155330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY MINETTE PHYSICAL THERAPY SERVICES

Provider Business Mailing Address
First Line	:	1512 SOUTH HIGHWAY 31
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507
Country	:	US
Telephone Number	:	251-580-3232
Fax Number	:	251-580-3234

Provider Business Practice Location Address
First Line	:	1512 SOUTH HIGHWAY 31
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507
Country	:	US
Telephone Number	:	251-580-3232
Fax Number	:	251-580-3234

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. LINDA R. OVERSTREET
Credential	:	O.M.
Telephone Number	:	251-580-3232

Provider Enumeration Date	:	05/28/2010
Last Update Date	:	05/28/2010

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