Provider Demographics
NPI:1376309351
Name:ULTR SPORTS PERFORMANCE, INC.
Entity Type:Organization
Organization Name:ULTR SPORTS PERFORMANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HEAD TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-236-0222
Mailing Address - Street 1:7733 BALLANTYNE COMMONS PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4398
Mailing Address - Country:US
Mailing Address - Phone:704-236-0222
Mailing Address - Fax:
Practice Address - Street 1:7733 BALLANTYNE COMMONS PKWY STE 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4398
Practice Address - Country:US
Practice Address - Phone:704-236-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty