Provider Demographics
NPI:1003422064
Name:PURPOSE PHYSICAL THERAPY AND WELLNESS, LLC
Entity Type:Organization
Organization Name:PURPOSE PHYSICAL THERAPY AND WELLNESS, LLC
Other - Org Name:PURPOSE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT
Authorized Official - Phone:417-315-5577
Mailing Address - Street 1:1190 28TH AVE N UNIT 1/2
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-2523
Mailing Address - Country:US
Mailing Address - Phone:417-315-5577
Mailing Address - Fax:
Practice Address - Street 1:6619 1ST AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1305
Practice Address - Country:US
Practice Address - Phone:417-315-5777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty