Provider Demographics
NPI:1649392051
Name:AZALEA CITY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:AZALEA CITY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BREITUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:251-470-7772
Mailing Address - Street 1:316C S SAGE AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3616
Mailing Address - Country:US
Mailing Address - Phone:251-470-7772
Mailing Address - Fax:251-470-7773
Practice Address - Street 1:316C S SAGE AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3616
Practice Address - Country:US
Practice Address - Phone:251-470-7772
Practice Address - Fax:251-470-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty