Provider Demographics
NPI:1275005217
Name:POWELL, MISTY MICHELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:MICHELLE
Last Name:POWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 360884
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35236-0884
Mailing Address - Country:US
Mailing Address - Phone:205-823-1215
Mailing Address - Fax:205-822-4999
Practice Address - Street 1:700 CENTURY PARK SOUTH
Practice Address - Street 2:SUITE 128
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226-3984
Practice Address - Country:US
Practice Address - Phone:205-823-1215
Practice Address - Fax:205-822-4999
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251P0200X
ALPTH2604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics