Provider Demographics
NPI:1841736618
Name:PROOF PHYSICAL THERAPY AND PERFORMANCE, LLC
Entity Type:Organization
Organization Name:PROOF PHYSICAL THERAPY AND PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-440-3106
Mailing Address - Street 1:460 N SWITZER CANYON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4851
Mailing Address - Country:US
Mailing Address - Phone:928-440-3106
Mailing Address - Fax:928-438-6702
Practice Address - Street 1:460 N SWITZER CANYON DR STE 400
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4851
Practice Address - Country:US
Practice Address - Phone:928-440-3106
Practice Address - Fax:928-438-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ109152251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty