Provider Demographics
NPI:1477762458
Name:FRANKLIN COUNTY PHYSICAL THERAPY & SPORTS MEDICINE, INC.
Entity Type:Organization
Organization Name:FRANKLIN COUNTY PHYSICAL THERAPY & SPORTS MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:EMNACE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:256-331-9555
Mailing Address - Street 1:204 LAWRENCE ST W
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-2240
Mailing Address - Country:US
Mailing Address - Phone:256-331-9555
Mailing Address - Fax:256-332-9989
Practice Address - Street 1:204 LAWRENCE ST W
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-2240
Practice Address - Country:US
Practice Address - Phone:256-331-9555
Practice Address - Fax:256-332-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP13053Medicare UPIN