Provider Demographics
NPI:1467196451
Name:REFINE PT AND PERFORMANCE - EAST ALABAMA LLC
Entity Type:Organization
Organization Name:REFINE PT AND PERFORMANCE - EAST ALABAMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:THIBODEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-227-9464
Mailing Address - Street 1:1324 ROSS CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-4117
Mailing Address - Country:US
Mailing Address - Phone:334-769-2003
Mailing Address - Fax:334-769-2004
Practice Address - Street 1:1324 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4117
Practice Address - Country:US
Practice Address - Phone:334-769-2003
Practice Address - Fax:334-769-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty