Provider Demographics
NPI:1619935533
Name:ALABAMA PHYSICAL REHABILITATION SERVICES INC
Entity Type:Organization
Organization Name:ALABAMA PHYSICAL REHABILITATION SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KLUG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:256-435-9386
Mailing Address - Street 1:1475 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-3337
Mailing Address - Country:US
Mailing Address - Phone:256-435-9386
Mailing Address - Fax:256-435-2053
Practice Address - Street 1:1475 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3337
Practice Address - Country:US
Practice Address - Phone:256-435-9386
Practice Address - Fax:256-435-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR0803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529601780Medicaid
AL016619Medicare Oscar/Certification