Provider Demographics
NPI:1518339001
Name:SPECIALIZED THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:SPECIALIZED THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:VAN CAMP
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, PRPC, BCB-PMD
Authorized Official - Phone:251-990-9082
Mailing Address - Street 1:2200 US HIGHWAY 98 STE 4
Mailing Address - Street 2:#320
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4382
Mailing Address - Country:US
Mailing Address - Phone:251-990-9082
Mailing Address - Fax:251-990-3707
Practice Address - Street 1:8720 RAND AVE
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9102
Practice Address - Country:US
Practice Address - Phone:251-990-9082
Practice Address - Fax:251-990-3707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH-3828225100000X, 2251N0400X, 2251X0800X, 225100000X
AL0615225XN1300X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty