Provider Demographics
NPI:1629554662
Name:WIREGRASS THERAPY SOLUTIONS INC
Entity Type:Organization
Organization Name:WIREGRASS THERAPY SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:ALON
Authorized Official - Last Name:LIPSCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:334-793-1081
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-0986
Mailing Address - Country:US
Mailing Address - Phone:334-791-1081
Mailing Address - Fax:334-792-7600
Practice Address - Street 1:418 N FOSTER ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-4545
Practice Address - Country:US
Practice Address - Phone:334-793-1081
Practice Address - Fax:334-792-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty