Provider Demographics
NPI:1760662233
Name:THERASPORT
Entity Type:Organization
Organization Name:THERASPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT, ATC
Authorized Official - Phone:256-638-1150
Mailing Address - Street 1:PO BOX 1966
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-1966
Mailing Address - Country:US
Mailing Address - Phone:256-638-1150
Mailing Address - Fax:
Practice Address - Street 1:598 MAIN ST E
Practice Address - Street 2:
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986-4541
Practice Address - Country:US
Practice Address - Phone:256-638-1150
Practice Address - Fax:256-638-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3371261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51514927OtherBLUE CROSS BLUS SHIELD
AL51514927OtherBLUE CROSS BLUS SHIELD