Provider Demographics
NPI:1013114065
Name:PROHEALTH PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:PROHEALTH PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:256-997-9991
Mailing Address - Street 1:1906 GLENN BLVD SW STE 1000
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3547
Mailing Address - Country:US
Mailing Address - Phone:256-997-9991
Mailing Address - Fax:256-997-9950
Practice Address - Street 1:1906 GLENN BLVD SW STE 1000
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3547
Practice Address - Country:US
Practice Address - Phone:256-997-9991
Practice Address - Fax:256-997-9950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3406251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)