Basic Information
| Provider Information | |||||||||
| NPI: | 1881841419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHILDRESS | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 92 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366010092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514457912 | ||||||||
| FaxNumber: | 2514315810 | ||||||||
| Practice Location | |||||||||
| Address1: | 5320 US HWY 90 SERVICE RD | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514457912 | ||||||||
| FaxNumber: | 2514315810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2008 | ||||||||
| LastUpdateDate: | 08/26/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 24040 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.