Provider Demographics
NPI:1023240306
Name:ORTHOPEDIC REHABILITATION AND TRAINING
Entity type:Organization
Organization Name:ORTHOPEDIC REHABILITATION AND TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:334-221-1870
Mailing Address - Street 1:211 SWEET BRIAR LANE
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067
Mailing Address - Country:US
Mailing Address - Phone:334-221-1870
Mailing Address - Fax:
Practice Address - Street 1:211 SWEETBRIAR LN
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-1935
Practice Address - Country:US
Practice Address - Phone:334-221-1870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy