MEDICARE: BAY MINETTE 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1235092628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY MINETTE PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	1512 S US HIGHWAY 31
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-2611
Country	:	US
Telephone Number	:	251-580-3232
Fax Number	:	251-580-3234

Provider Business Practice Location Address
First Line	:	1512 S US HIGHWAY 31
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-2611
Country	:	US
Telephone Number	:	251-580-3232
Fax Number	:	251-580-3234

Authorized Official
Title or Position	:	DIR OF CREDENTIALING AND ACC PAYABL
Name	:	PAMELA P VAN ETTEN
Credential	:
Telephone Number	:	334-799-5853

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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