Provider Demographics
NPI:1609630391
Name:PRO PERFORMANCE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:PRO PERFORMANCE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:404-666-1990
Mailing Address - Street 1:303 HAYGOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30054-2241
Mailing Address - Country:US
Mailing Address - Phone:404-786-1249
Mailing Address - Fax:
Practice Address - Street 1:1000 IRIS DR SW STE G4
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6648
Practice Address - Country:US
Practice Address - Phone:404-666-1990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy