| Name: | Fourroux Therapy Services, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 13 May 2009 (16 years ago) |
| Date of dissolution: | 20 Sep 2016 |
| Entity Number: | 000-433-786 |
| Register Number: | 000433786 |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | HUNTSVILLE, AL |
| Registered Office Street Address: | 2743 BOB WALLACE AVE SWHUNTSVILLE, AL 35805 |
| Registered Office Street Address ZIP Code: | 35805 |
Activities
PROVIDE THERAPY/RELATED SERVICES TO AMPUTEES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043231079 | 2006-07-23 | 2013-02-04 | 2743 BOB WALLACE AVE SW, HUNTSVILLE, AL, 358054103, US | 2743 BOB WALLACE AVE SW, HUNTSVILLE, AL, 358054103, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 256-534-8672 |
| Fax | 2565399755 |
Authorized person
| Name | MR. WILLIAM KEITH WATSON |
| Role | OWNER |
| Phone | 2565348672 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | 18990 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51532259 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529928640 |
| State | AL |
| Issuer | TRICARE |
| Number | 631283106 |
| Name | Role | Address |
|---|---|---|
| WATSON, KEITH | Agent | 2743 BOB WALLACE AVENUE SW SUITE CHUNTSVILLE, AL 35805 |
| Name | Role | Address |
|---|---|---|
| FOURROUX, MARVIN | Member | No data |
| WATSON, KEITH | Member | 2743 BOB WALLACE AVENUE SW SUITE CHUNTSVILLE, AL 35805 |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
