Provider Demographics
NPI:1578323861
Name:FUTURE ALL AMERICAN SPORTS THERAPY ELITE REHABILITATION LLC
Entity Type:Organization
Organization Name:FUTURE ALL AMERICAN SPORTS THERAPY ELITE REHABILITATION LLC
Other - Org Name:FASTERPT LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COVAUGHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBOSKIE-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-440-0341
Mailing Address - Street 1:4930 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5615
Mailing Address - Country:US
Mailing Address - Phone:520-440-0341
Mailing Address - Fax:
Practice Address - Street 1:4930 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5615
Practice Address - Country:US
Practice Address - Phone:520-440-0341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty