Provider Demographics
NPI:1598790065
Name:PROMISE PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:PROMISE PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:PRICE
Authorized Official - Last Name:GRICE
Authorized Official - Suffix:III
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:334-358-2201
Mailing Address - Street 1:640 MCQUEEN SMITH RD N
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7511
Mailing Address - Country:US
Mailing Address - Phone:334-358-2201
Mailing Address - Fax:334-358-2236
Practice Address - Street 1:640 MCQUEEN SMITH RD N
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7511
Practice Address - Country:US
Practice Address - Phone:334-358-2201
Practice Address - Fax:334-358-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPT1534261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51515426OtherBLUE CROSS BLUE SHIELD
AL051515426Medicare ID - Type Unspecified
AL51515426OtherBLUE CROSS BLUE SHIELD