NPIMap

Organization Active NPI

Dothan Therapy Associates Inc

Doing business as Physical Therapy Specialists of Dothan

  • Physical Therapist
  • Dothan, AL
National Provider Identifier
1477647816
Registry record updated Sep 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
DOTHAN THERAPY ASSOCIATES INC
Doing business as
Physical Therapy Specialists of Dothan
Practice address
3118 Ross Clark Circle
Dothan, AL 36303
Phone
(334) 673-2422
Fax
(334) 673-2425
NPI assigned
Oct 2, 2006
Last updated
Sep 27, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
DOTHAN THERAPY ASSOCIATES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 27, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Charles Outlaw, PTNPI 1033168653
Title
Owner
Phone
(334) 673-2422

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

3118 Ross Clark Circle
Dothan, AL 36303

Mailing address

3118 Ross Clark Circle
Dothan, AL 36303
Phone (334) 673-2422

Other identifiers 2

IdentifierTypeStateIssuer
529912880MedicaidAL
Q677OtherALBC BS OF ALABAMA GROUP #

Other names 1

  • Physical Therapy Specialists of Dothan Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050330001042 AL Part B Supplier - Clinic/Group Practice 5799731972 Receives reassigned benefits from 7 practitioners
Practice locations: Dothan, AL
O20180711003968 AL DME Supplier - Independently-Practicing Physical Therapist 5799731972 Practice locations: Dothan, AL

National Provider Directory

National Provider Directory
Part of
Dothan Therapy Assoc

Locations

3118 Ross Clark Cir
Dothan, AL 36303
Phone (334) 673-2242

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664236800000",
    "number": "1477647816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3118 ROSS CLARK CIRCLE",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "36303",
            "telephone_number": "334-673-2422",
            "fax_number": "334-673-2425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3118 ROSS CLARK CIRCLE",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "36303",
            "telephone_number": "334-673-2422",
            "fax_number": "334-673-2425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOTHAN THERAPY ASSOCIATES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DOTHAN THERAPY ASSOCIATES INC",
        "enumeration_date": "2006-10-02",
        "last_updated": "2022-09-27",
        "certification_date": "2022-09-27",
        "status": "A",
        "authorized_official_last_name": "OUTLAW",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "334-673-2422",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529912880",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF ALABAMA GROUP #",
            "identifier": "Q677",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physical Therapy Specialists of Dothan",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Physical Therapy Specialists of Dothan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.