Provider Demographics
NPI:1689346405
Name:REFINE PT AND PERFORMANCE - NORTH ALABAMA LLC
Entity Type:Organization
Organization Name:REFINE PT AND PERFORMANCE - NORTH ALABAMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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 1:1111 KNIGHT ST SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6501
Mailing Address - Country:US
Mailing Address - Phone:256-973-1552
Mailing Address - Fax:256-973-1553
Practice Address - Street 1:1111 KNIGHT ST SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6501
Practice Address - Country:US
Practice Address - Phone:256-973-1552
Practice Address - Fax:256-973-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty