| Name: | NICHOLSON PHYSICAL THERAPY, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 06 Jun 2017 (7 years ago) |
| Entity Number: | 000-393-465 |
| Register Number: | 000393465 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 1912 MAYFLOWER DRIVEHOOVER, AL 35226 |
| Registered Office Street Address ZIP Code: | 35226 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588188221 | 2017-08-02 | 2017-08-02 | 1912 MAYFLOWER DR, HOOVER, AL, 352263316, US | 216 LORNA SQ, HOOVER, AL, 352165439, US | |||||||||||||||||||||||
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| Phone | +1 205-377-6960 |
| Fax | 2054492536 |
Authorized person
| Name | GARVICE GARRETT NICHOLSON JR. |
| Role | OWNER |
| Phone | 2053776960 |
Taxonomy
| Taxonomy Code | 261QP2000X - Physical Therapy Clinic/Center |
| License Number | PTH363 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 1275651572 |
| Name | Role | Address |
|---|---|---|
| NICHOLSON, GARVICE G | Agent | 1912 MAYFLOWER DRIVEHOOVER, AL 35226 |
| Name | Role | Address |
|---|---|---|
| NICHOLSON, GARVICE G | Organizer | 1912 MAYFLOWER DRIVEHOOVER, AL 35226 |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
