Provider Demographics
NPI:1205965175
Name:INDUSTRIAL WELLNESS REHAB, INC
Entity type:Organization
Organization Name:INDUSTRIAL WELLNESS REHAB, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP-ACCTS RECEIVABLE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:W
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-586-0067
Mailing Address - Street 1:2048 S BROAD ST # A
Mailing Address - Street 2:BROOKLEY COMPLEX
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36615-1285
Mailing Address - Country:US
Mailing Address - Phone:251-433-1414
Mailing Address - Fax:251-433-9634
Practice Address - Street 1:627 HIGHWAY 43 SOUTH
Practice Address - Street 2:SUITE B
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571
Practice Address - Country:US
Practice Address - Phone:251-675-3390
Practice Address - Fax:251-675-9976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI744Medicare ID - Type UnspecifiedSARALAND FACILITY NUMBER