Provider Demographics
NPI:1437214574
Name:INDUSTRIAL WELLNESS REHAB, INC
Entity Type:Organization
Organization Name:INDUSTRIAL WELLNESS REHAB, INC
Other - Org Name:IWR THERAPY SYSTEMS
Other - Org Type:Other Name
Authorized Official - Title/Position:VP-ACCTS RECEIVABLE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:W
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-433-1414
Mailing Address - Street 1:2048A S BROAD ST
Mailing Address - Street 2:BROOKLEY COMPLEX
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36615-1285
Mailing Address - Country:US
Mailing Address - Phone:251-433-1414
Mailing Address - Fax:251-433-9634
Practice Address - Street 1:2048A S BROAD ST
Practice Address - Street 2:BROOKLEY COMPLEX
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36615-1285
Practice Address - Country:US
Practice Address - Phone:251-433-1414
Practice Address - Fax:251-433-9634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1122225100000X
ALPTH1919225100000X
ALPTH4083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-14905OtherBCBS - DEBORAH NELSON - BROOKLEY LOCATION
AL102I650307OtherMEDICARE PTAN - DEBORAH NELSON - BROOKLEY
AL510I650221OtherMEDICARE PTAN - BEVERLY WILKINS PT - BROOKLEY LOCATION
AL510I650231OtherMEDICARE PTAN - WILLIAM H FARNELL - BROOKLEY LOCATION
AL000074865Medicare ID - Type UnspecifiedBEVERLY WILKINS, RPT
AL511-14905OtherBCBS - DEBORAH NELSON - BROOKLEY LOCATION