Provider Demographics
NPI:1013199876
Name:TOTAL LIFE CONNECTION PHYSICAL THERAPY CENTER
Entity Type:Organization
Organization Name:TOTAL LIFE CONNECTION PHYSICAL THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:H
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:334-244-5061
Mailing Address - Street 1:6709 TAYLOR CIR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7706
Mailing Address - Country:US
Mailing Address - Phone:334-244-5061
Mailing Address - Fax:334-244-5062
Practice Address - Street 1:6709 TAYLOR CIR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7706
Practice Address - Country:US
Practice Address - Phone:334-244-5061
Practice Address - Fax:334-244-5062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25540305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization