Provider Demographics
NPI:1497861926
Name:IMPACT REHABILITATION AND SPORTS MEDICINE, INC.
Entity type:Organization
Organization Name:IMPACT REHABILITATION AND SPORTS MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHADWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-621-3077
Mailing Address - Street 1:PO BOX 1694
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-1694
Mailing Address - Country:US
Mailing Address - Phone:205-621-3077
Mailing Address - Fax:205-621-3788
Practice Address - Street 1:101 CARRINGTON LN STE C
Practice Address - Street 2:
Practice Address - City:CALERA
Practice Address - State:AL
Practice Address - Zip Code:35040-5439
Practice Address - Country:US
Practice Address - Phone:205-621-3077
Practice Address - Fax:205-621-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL50727OtherHEALTH SPRING
AL51534667OtherCHRISTY BCBS
AL438219695OtherTRI-CARE
AL51535738OtherSUZI BCBS
ALAETNAOther7176438
AL438219695OtherTRI-CARE