Provider Demographics
NPI:1063421857
Name:THERAFIT, LLC
Entity type:Organization
Organization Name:THERAFIT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:256-829-9544
Mailing Address - Street 1:12819 HWY 231 431 N
Mailing Address - Street 2:SUITE G
Mailing Address - City:HAZEL GREEN
Mailing Address - State:AL
Mailing Address - Zip Code:35750-8629
Mailing Address - Country:US
Mailing Address - Phone:256-829-9544
Mailing Address - Fax:256-829-9522
Practice Address - Street 1:12819 HWY 231 431 N
Practice Address - Street 2:SUITE G
Practice Address - City:HAZEL GREEN
Practice Address - State:AL
Practice Address - Zip Code:35750-8629
Practice Address - Country:US
Practice Address - Phone:256-829-9544
Practice Address - Fax:256-829-9522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529919850Medicaid
TN4091622OtherBLUE CROSS BLUE SHIELD
AL1063421857OtherBLUE CROSS BLUE SHIELD
TN103G709365Medicare PIN
AL1063421857OtherBLUE CROSS BLUE SHIELD