Provider Demographics
NPI:1407613870
Name:FORWARD PHYSICAL THERAPY AND PERFORMANCE, LLC
Entity Type:Organization
Organization Name:FORWARD PHYSICAL THERAPY AND PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:GUNSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:440-225-1425
Mailing Address - Street 1:2816 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-8630
Mailing Address - Country:US
Mailing Address - Phone:440-225-1425
Mailing Address - Fax:
Practice Address - Street 1:2816 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8630
Practice Address - Country:US
Practice Address - Phone:440-225-1425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty