Provider Demographics
NPI:1760262430
Name:PHYSICAL THERAPY AND PERFORMANCE TRAINING LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY AND PERFORMANCE TRAINING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIM
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:908-487-1936
Mailing Address - Street 1:1105 TOWN BLVD NE UNIT 2720
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3688
Mailing Address - Country:US
Mailing Address - Phone:908-487-1936
Mailing Address - Fax:
Practice Address - Street 1:1105 TOWN BLVD NE UNIT 2720
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3688
Practice Address - Country:US
Practice Address - Phone:908-487-1936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy