Provider Demographics
NPI:1346424769
Name:THERAPY SOUTH LLC FULTONDALE
Entity Type:Organization
Organization Name:THERAPY SOUTH LLC FULTONDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-745-3651
Mailing Address - Street 1:2807 GREYSTONE COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 34
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-9600
Mailing Address - Country:US
Mailing Address - Phone:205-745-3660
Mailing Address - Fax:205-408-4209
Practice Address - Street 1:3471 LOWERY PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:FULTONDALE
Practice Address - State:AL
Practice Address - Zip Code:35068-1680
Practice Address - Country:US
Practice Address - Phone:205-849-6566
Practice Address - Fax:205-849-6563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty