# PHYSICAL EXPRESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043362734
- **Authorized official:** MRS. JADE LANE (CREDENTIALING MANAGER)
- **Authorized official phone:** (334) 567-4311

## Contact information

- **Practice address:** 4081 ALABAMA HWY 14, MILLBROOK, AL 36054
- **Practice address phone:** (334) 285-3222
- **Practice address fax:** (334) 285-6555
- **Mailing address:** PO BOX 688, MILLBROOK, AL 36054-0014
- **Mailing address phone:** (334) 285-3222
- **Mailing address fax:** (334) 285-6555

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/16/2007
- **Last updated:** 03/20/2025