Provider Demographics
NPI:1043231079
Name:FOURROUX THERAPY SERVICES, L.L.C.
Entity Type:Organization
Organization Name:FOURROUX THERAPY SERVICES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:256-534-8672
Mailing Address - Street 1:2743 BOB WALLACE AVE SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-4103
Mailing Address - Country:US
Mailing Address - Phone:256-534-8672
Mailing Address - Fax:256-539-9755
Practice Address - Street 1:2743 BOB WALLACE AVE SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-4103
Practice Address - Country:US
Practice Address - Phone:256-534-8672
Practice Address - Fax:256-539-9755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51532259OtherBLUE CROSS BLUE SHIELD
AL529928640Medicaid
631283106OtherTRICARE