Basic Information
| Provider Information | |||||||||
| NPI: | 1053446286 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHAB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 GOVERNORS DRIVE 1ST FLOOR | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358015123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565331600 | ||||||||
| FaxNumber: | 2565390856 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 GOVERNORS DRIVE 1ST FLOOR | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358015123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565331600 | ||||||||
| FaxNumber: | 2565390856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 01/11/2013 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2565331600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | G110 | 01 | AL | BCBS AL | OTHER |