Provider Demographics
NPI:1154450153
Name:INDUSTRIAL WELLNESS REHAB, INC.
Entity Type:Organization
Organization Name:INDUSTRIAL WELLNESS REHAB, INC.
Other - Org Name:IWR THERAPY SYSTEMS
Other - Org Type:Other Name
Authorized Official - Title/Position:VP- ACCTS RECEIVABLE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:W
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-433-1414
Mailing Address - Street 1:2048 S BROAD ST # A
Mailing Address - Street 2:BROOKLEY COMPLEX
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36615-1285
Mailing Address - Country:US
Mailing Address - Phone:251-433-1414
Mailing Address - Fax:251-433-9634
Practice Address - Street 1:7965 MOFFETT RD
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-5409
Practice Address - Country:US
Practice Address - Phone:251-645-3708
Practice Address - Fax:251-645-5837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0515-17279OtherBCBS PROV#- W.H. FARNELL
AL0515-17279OtherBCBS PROV#- W.H. FARNELL
AL515-24913Medicare PIN