Provider Demographics
NPI:1114586633
Name:POWER PHYSICAL THERAPY AND PERFORMANCE, PLLC
Entity Type:Organization
Organization Name:POWER PHYSICAL THERAPY AND PERFORMANCE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:618-978-7607
Mailing Address - Street 1:10130 HAMMERSMITH LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0336
Mailing Address - Country:US
Mailing Address - Phone:618-978-7607
Mailing Address - Fax:
Practice Address - Street 1:556 TRINITY CREEK CV STE A
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-2279
Practice Address - Country:US
Practice Address - Phone:901-231-5540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-08
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty