Provider Demographics
NPI:1528317849
Name:EAST ALABAMA SPECIALTY THERAPY CLINIC, LLC
Entity type:Organization
Organization Name:EAST ALABAMA SPECIALTY THERAPY CLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:BELLE
Authorized Official - Last Name:LOMBARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MCD, CCC-SLP
Authorized Official - Phone:334-759-0111
Mailing Address - Street 1:2415 MOORES MILL RD
Mailing Address - Street 2:SUITE 265-128
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-8480
Mailing Address - Country:US
Mailing Address - Phone:334-759-0111
Mailing Address - Fax:334-521-7251
Practice Address - Street 1:1805 RAYMER PL
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-2187
Practice Address - Country:US
Practice Address - Phone:334-759-0111
Practice Address - Fax:334-521-7251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty