# THERAPY SOUTH - GLUCKSTADT LLC

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

## Provider details

- **NPI number:** 1134784689
- **Authorized official:** HANNAH KELLY (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (205) 745-3660

## Contact information

- **Practice address:** 1716 US 51, STE N, MADISON, MS 39110
- **Practice address phone:** (601) 499-5780
- **Mailing address:** 2823 GREYSTONE COMMERCIAL BLVD, BIRMINGHAM, AL 35242-2660
- **Mailing address phone:** (205) 745-3660

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 05/09/2019
- **Last updated:** 06/17/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 6014995780 | PHONE NUMBER | MS |