Provider Demographics
NPI:1790824274
Name:MONTGOMERY EAST PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:MONTGOMERY EAST PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SUBLETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:334-244-5892
Mailing Address - Street 1:499 SAINT LUKES DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7105
Mailing Address - Country:US
Mailing Address - Phone:334-244-5892
Mailing Address - Fax:334-244-5890
Practice Address - Street 1:499 SAINT LUKES DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7105
Practice Address - Country:US
Practice Address - Phone:334-244-5892
Practice Address - Fax:334-244-5890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529700330Medicaid
AL529700330Medicaid