Provider Demographics
NPI:1073777223
Name:MILLENNIUM PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MILLENNIUM PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:205-365-7602
Mailing Address - Street 1:4863 PROMENADE PKWY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-7305
Mailing Address - Country:US
Mailing Address - Phone:205-481-9012
Mailing Address - Fax:205-481-9014
Practice Address - Street 1:4847 PROMENADE PKWY STE 102
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-7310
Practice Address - Country:US
Practice Address - Phone:205-481-9012
Practice Address - Fax:205-481-9014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty