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Total Rehab Physical Therapy, LLC

Details

Name: Total Rehab Physical Therapy, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Dissolved
Date of registration: 22 Oct 2002 (22 years ago) (Companies founded in October 2002)
Date of dissolution: 13 Apr 2022
Entity Number: 000-685-484
Register Number: 000685484
ZIP code: 36830 (Companies in Lee, 36830)
County: Lee
Place of Formation: Lee County
Principal Address: AUBURN, AL
Registered Office Street Address: 2515 E GLENN AVE STE 104AUBURN, AL 36830

Activities PHYSICAL THERAPY

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1407047574 2007-08-05 2007-08-05 2515 E GLENN AVE, SUITE 104, AUBURN, AL, 368306453, US 2515 E GLENN AVE, SUITE 104, AUBURN, AL, 368306453, US

Contacts

Phone +1 334-821-2256
Fax 3348268082

Authorized person

Name THOMAS EVANS
Role PHYSICAL THERAPIST
Phone 3348212256

Taxonomy

Taxonomy Code 225100000X - Physical Therapist
License Number PTH2853
State AL
Is Primary Yes

Other Provider Identifiers

Issuer BLUECROSS BLUESHIELD
Number 51512447
State AL
Issuer PALMETTOGB-RAILROAD
Number P00039795
State AL

Agent

Name Role
EVANS, THOMAS D Agent

Member

Name Role
EVANS, THOMAS D Member
GARNER, TYLER M Member

Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State