Provider Demographics
NPI:1124790480
Name:RADIUS PT OF ALABAMA LLC
Entity type:Organization
Organization Name:RADIUS PT OF ALABAMA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CORPORATE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KEISLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-441-0595
Mailing Address - Street 1:7270 GADSDEN HWY # 104-108
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-2640
Mailing Address - Country:US
Mailing Address - Phone:659-444-1193
Mailing Address - Fax:205-895-6639
Practice Address - Street 1:7270 GADSDEN HWY # 104-108
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-2640
Practice Address - Country:US
Practice Address - Phone:659-444-1193
Practice Address - Fax:205-895-6639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-04
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty