Provider Demographics
NPI:1295350783
Name:P4 PHYSICAL THERAPY - ATHENS, LLC
Entity type:Organization
Organization Name:P4 PHYSICAL THERAPY - ATHENS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:205-478-4418
Mailing Address - Street 1:8059 MITCHELL LN
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-6821
Mailing Address - Country:US
Mailing Address - Phone:205-229-8376
Mailing Address - Fax:
Practice Address - Street 1:209 FITNESS WAY STE D
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2452
Practice Address - Country:US
Practice Address - Phone:205-478-4418
Practice Address - Fax:205-999-4622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty