Provider Demographics
NPI:1740355239
Name:THE THERAPY & WELLNESS GROUP, INC
Entity type:Organization
Organization Name:THE THERAPY & WELLNESS GROUP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS
Authorized Official - Phone:334-699-2348
Mailing Address - Street 1:3160 W MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1185
Mailing Address - Country:US
Mailing Address - Phone:334-699-2348
Mailing Address - Fax:334-699-2347
Practice Address - Street 1:3160 W MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1185
Practice Address - Country:US
Practice Address - Phone:334-699-2348
Practice Address - Fax:334-699-2347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-36404OtherBCBS OF ALABAMA
AL515-32301OtherBCBS OF ALABAMA
AL515-36412OtherBCBS OF ALABAMA
AL515-32258OtherBCBS OF ALABAMA
AL515-32258OtherBCBS OF ALABAMA
ALP81184Medicare UPIN