Provider Demographics
NPI:1285704270
Name:BEYOND PHYSICAL THERAPY OF VESTAVIA, LLC
Entity type:Organization
Organization Name:BEYOND PHYSICAL THERAPY OF VESTAVIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, ATC
Authorized Official - Phone:205-824-0610
Mailing Address - Street 1:100 CENTERVIEW DR STE 190
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-3774
Mailing Address - Country:US
Mailing Address - Phone:205-824-0610
Mailing Address - Fax:800-433-5134
Practice Address - Street 1:100 CENTERVIEW DR STE 190
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-3774
Practice Address - Country:US
Practice Address - Phone:205-824-0610
Practice Address - Fax:800-433-5134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL933303715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty