Provider Demographics
NPI:1790106201
Name:FUNCTIONAL ATHLETIC REHABILITATION & MOVEMENT
Entity Type:Organization
Organization Name:FUNCTIONAL ATHLETIC REHABILITATION & MOVEMENT
Other - Org Name:THE FARM
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS, CCSP
Authorized Official - Phone:205-419-1595
Mailing Address - Street 1:203 NARROWS PARKWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242
Mailing Address - Country:US
Mailing Address - Phone:205-419-1595
Mailing Address - Fax:205-724-9130
Practice Address - Street 1:203 NARROWS PARKWAY
Practice Address - Street 2:SUITE A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242
Practice Address - Country:US
Practice Address - Phone:205-419-1595
Practice Address - Fax:205-724-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2415111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty