Provider Demographics
NPI:1073916292
Name:IMPACT THERAPY, INC
Entity Type:Organization
Organization Name:IMPACT THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:205-559-3688
Mailing Address - Street 1:200 MEDICAL ST
Mailing Address - Street 2:
Mailing Address - City:SNEAD
Mailing Address - State:AL
Mailing Address - Zip Code:35952-6593
Mailing Address - Country:US
Mailing Address - Phone:205-559-3688
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL ST
Practice Address - Street 2:
Practice Address - City:SNEAD
Practice Address - State:AL
Practice Address - Zip Code:35952-6593
Practice Address - Country:US
Practice Address - Phone:205-559-3688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4018261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy