Provider Demographics
NPI:1801065537
Name:PHYSICAL THERAPY OF ANDALUSIA
Entity type:Organization
Organization Name:PHYSICAL THERAPY OF ANDALUSIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:334-222-5785
Mailing Address - Street 1:1105 W BYPASS
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-5255
Mailing Address - Country:US
Mailing Address - Phone:334-222-5785
Mailing Address - Fax:334-222-8062
Practice Address - Street 1:1105 W BYPASS
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5255
Practice Address - Country:US
Practice Address - Phone:334-222-5785
Practice Address - Fax:334-222-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH551261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR62961Medicare UPIN
AL000073802Medicare PIN