Provider Demographics
NPI:1710964929
Name:PIERCE, JOSEPH BROWN JR (RPT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BROWN
Last Name:PIERCE
Suffix:JR
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1811 OLD SHELL RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3416
Mailing Address - Country:US
Mailing Address - Phone:251-479-1149
Mailing Address - Fax:251-479-1118
Practice Address - Street 1:1811 OLD SHELL RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3416
Practice Address - Country:US
Practice Address - Phone:251-479-1149
Practice Address - Fax:251-479-1118
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
630730034OtherTRICARE
P00191425OtherRAILROAD MEDICARE
AL51072066OtherBLUE CROSS BLUE SHIELD
P00191425OtherRAILROAD MEDICARE
AL51072066OtherBLUE CROSS BLUE SHIELD