Basic Information
Provider Information
NPI: 1194391789
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOOD
FirstName: ELIJAH
MiddleName: CADE
NamePrefix:  
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1200 CORPORATE DR STE 400
Address2:  
City: HOOVER
State: AL
PostalCode: 352425424
CountryCode: US
TelephoneNumber: 4232387217
FaxNumber: 4239331996
Practice Location
Address1: 2503 VIRGINIA LN
Address2:  
City: CORINTH
State: MS
PostalCode: 388346530
CountryCode: US
TelephoneNumber: 6629777180
FaxNumber: 6629777182
Other Information
ProviderEnumerationDate: 06/03/2021
LastUpdateDate: 06/03/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/03/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT7101MSY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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