Provider Demographics
NPI:1811681653
Name:256 PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:256 PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:KIMBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:931-629-1323
Mailing Address - Street 1:25 SHOALS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-3257
Mailing Address - Country:US
Mailing Address - Phone:931-629-1323
Mailing Address - Fax:
Practice Address - Street 1:659 COX CREEK PKWY STE A
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6621
Practice Address - Country:US
Practice Address - Phone:931-629-1323
Practice Address - Fax:256-666-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty