Provider Demographics
NPI:1922165042
Name:PURVIS, RIEN STEPHEN (LMT)
Entity Type:Individual
Prefix:MR
First Name:RIEN
Middle Name:STEPHEN
Last Name:PURVIS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 ALDON ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-3607
Mailing Address - Country:US
Mailing Address - Phone:360-977-3755
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:1410 ALDON ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-3607
Practice Address - Country:US
Practice Address - Phone:360-977-3755
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017755174400000X, 172M00000X, 225700000X
AL6053172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6053OtherMECHANOTHERAPY
WAMA00017755OtherMECHANOTHERAPY