Provider Demographics
NPI:1114531167
Name:ACTION POTENTIAL - SPORTS AND NEUROLOGICAL REHAB, PLLC
Entity Type:Organization
Organization Name:ACTION POTENTIAL - SPORTS AND NEUROLOGICAL REHAB, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHASE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-241-7803
Mailing Address - Street 1:5611 MAPLELEAF DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-2626
Mailing Address - Country:US
Mailing Address - Phone:253-241-7803
Mailing Address - Fax:
Practice Address - Street 1:5611 MAPLELEAF DR UNIT A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2626
Practice Address - Country:US
Practice Address - Phone:253-241-7803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-06
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center