Provider Demographics
NPI:1831681410
Name:LEGACY PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:LEGACY PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER / PTA
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:STINNETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPTA
Authorized Official - Phone:256-325-2130
Mailing Address - Street 1:3825 SULLIVAN STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35749-3147
Mailing Address - Country:US
Mailing Address - Phone:256-325-2130
Mailing Address - Fax:256-325-2142
Practice Address - Street 1:3825 SULLIVAN STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35747-3147
Practice Address - Country:US
Practice Address - Phone:256-325-2130
Practice Address - Fax:256-325-2142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
ALPTA5605261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy