Provider Demographics
NPI:1881841419
Name:CHILDRESS, VIRGINIA LEIGH
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LEIGH
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36601-0092
Mailing Address - Country:US
Mailing Address - Phone:251-445-7912
Mailing Address - Fax:251-431-5810
Practice Address - Street 1:5320 US HWY 90 SERVICE RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619
Practice Address - Country:US
Practice Address - Phone:251-445-7912
Practice Address - Fax:251-431-5810
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist