Provider Demographics
NPI:1780059972
Name:COMPLETE PHYSICAL THERAPY SPINAL RESTORATION ASSOCIATES, INC.
Entity type:Organization
Organization Name:COMPLETE PHYSICAL THERAPY SPINAL RESTORATION ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMRIC
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:256-461-7173
Mailing Address - Street 1:8097 MADISON BLVD
Mailing Address - Street 2:# 102
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2044
Mailing Address - Country:US
Mailing Address - Phone:256-461-7173
Mailing Address - Fax:
Practice Address - Street 1:8097 MADISON BLVD
Practice Address - Street 2:# 102
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2044
Practice Address - Country:US
Practice Address - Phone:256-461-7173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty