Provider Demographics
NPI:1336759257
Name:GODSPEED ESA HOOVER INC.
Entity Type:Organization
Organization Name:GODSPEED ESA HOOVER INC.
Other - Org Name:GODSPEED ELITE SPORTS ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING AND BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWTHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:205-292-2428
Mailing Address - Street 1:110 LITTLE VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2002
Mailing Address - Country:US
Mailing Address - Phone:205-292-2428
Mailing Address - Fax:
Practice Address - Street 1:110 LITTLE VALLEY CT
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2002
Practice Address - Country:US
Practice Address - Phone:205-292-2428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty