Provider Demographics
NPI:1760915748
Name:PHENIX CITY JOINT & REHAB, LLC
Entity Type:Organization
Organization Name:PHENIX CITY JOINT & REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:334-298-7700
Mailing Address - Street 1:PO BOX 1601
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36868-1601
Mailing Address - Country:US
Mailing Address - Phone:334-468-5770
Mailing Address - Fax:866-537-1711
Practice Address - Street 1:3700 S RAILROAD ST STE C
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-2994
Practice Address - Country:US
Practice Address - Phone:334-468-5770
Practice Address - Fax:866-537-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2019-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO9292081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty