Provider Demographics
NPI:1073120358
Name:FORGE PHYSIO & PERFORMANCE LLC
Entity Type:Organization
Organization Name:FORGE PHYSIO & PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALZHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:307-620-8172
Mailing Address - Street 1:350 A ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3726
Mailing Address - Country:US
Mailing Address - Phone:307-620-8172
Mailing Address - Fax:833-487-1072
Practice Address - Street 1:350 A ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3726
Practice Address - Country:US
Practice Address - Phone:307-620-8172
Practice Address - Fax:833-487-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty