Provider Demographics
NPI:1568001691
Name:POWERMILL PERFORMANCE, LLC
Entity Type:Organization
Organization Name:POWERMILL PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-763-9339
Mailing Address - Street 1:14828 BLAKELY WAY
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-1547
Mailing Address - Country:US
Mailing Address - Phone:325-763-9339
Mailing Address - Fax:
Practice Address - Street 1:14828 BLAKELY WAY
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-1547
Practice Address - Country:US
Practice Address - Phone:325-763-9339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy