Provider Demographics
NPI:1619172459
Name:TUSCALOOSA PHYSICAL THERAPY CENTER, INCORPORATED
Entity Type:Organization
Organization Name:TUSCALOOSA PHYSICAL THERAPY CENTER, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MARLOW
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:205-556-2110
Mailing Address - Street 1:1725 UNIVERSITY BLVD E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-2921
Mailing Address - Country:US
Mailing Address - Phone:205-556-2110
Mailing Address - Fax:205-556-2162
Practice Address - Street 1:1725 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2921
Practice Address - Country:US
Practice Address - Phone:205-556-2110
Practice Address - Fax:205-556-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH 3236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL74531OtherBCBS PROVIDER NUMBER
AL1295812352OtherNPI INDIVIDUAL NUMBER