Provider Demographics
NPI:1386643716
Name:MARSH PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:MARSH PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:O
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:205-342-2546
Mailing Address - Street 1:1792 MCFARLAND BLVD N
Mailing Address - Street 2:SUITE B
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2185
Mailing Address - Country:US
Mailing Address - Phone:205-342-2546
Mailing Address - Fax:205-342-2540
Practice Address - Street 1:1792 MCFARLAND BLVD N
Practice Address - Street 2:SUITE B
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2185
Practice Address - Country:US
Practice Address - Phone:205-342-2546
Practice Address - Fax:205-342-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-77696OtherKIM MARSH'S BC#