Provider Demographics
NPI:1003809955
Name:REHAB AND SPORTS MEDICINE OF THE SHOALS, INC
Entity Type:Organization
Organization Name:REHAB AND SPORTS MEDICINE OF THE SHOALS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-764-9304
Mailing Address - Street 1:1751 VETERANS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-4930
Mailing Address - Country:US
Mailing Address - Phone:256-718-3200
Mailing Address - Fax:256-764-9343
Practice Address - Street 1:1751 VETERANS DR STE 300
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4930
Practice Address - Country:US
Practice Address - Phone:256-718-3200
Practice Address - Fax:256-764-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK663Medicare PIN