Provider Demographics
NPI:1407224728
Name:LYSTRA PHYSICAL THERAPY AND WELLNESS, LLC
Entity Type:Organization
Organization Name:LYSTRA PHYSICAL THERAPY AND WELLNESS, LLC
Other - Org Name:ROBERT MALONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:256-325-2070
Mailing Address - Street 1:8331 MADISON BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2068
Mailing Address - Country:US
Mailing Address - Phone:256-325-2070
Mailing Address - Fax:844-587-9612
Practice Address - Street 1:8331 MADISON BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2068
Practice Address - Country:US
Practice Address - Phone:256-325-2070
Practice Address - Fax:844-587-9612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4294261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy