Provider Demographics
NPI:1386821320
Name:FOUNDATIONAL PHYSICAL THERAPY & MESSAGE
Entity Type:Organization
Organization Name:FOUNDATIONAL PHYSICAL THERAPY & MESSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:PT LMT
Authorized Official - Phone:251-458-3570
Mailing Address - Street 1:5350 GRAND BAY WILMER RD SOUTH
Mailing Address - Street 2:
Mailing Address - City:GRAND BAY
Mailing Address - State:AL
Mailing Address - Zip Code:36541-5438
Mailing Address - Country:US
Mailing Address - Phone:251-458-3570
Mailing Address - Fax:251-865-9436
Practice Address - Street 1:319 PINEHILL DRIVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-1735
Practice Address - Country:US
Practice Address - Phone:251-458-3570
Practice Address - Fax:251-865-9436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4Z16225100000X
AL2268225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty