Provider Demographics
NPI:1851083117
Name:PERFORM PHYSICAL THERAPY & WELLNESS LLC
Entity Type:Organization
Organization Name:PERFORM PHYSICAL THERAPY & WELLNESS LLC
Other - Org Name:PERFORM PHYSICAL THERAPY & WELLNESS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITNEY
Authorized Official - Middle Name:WETHERINGTON
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, SCS
Authorized Official - Phone:912-515-5869
Mailing Address - Street 1:27 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-4757
Mailing Address - Country:US
Mailing Address - Phone:912-515-5869
Mailing Address - Fax:
Practice Address - Street 1:27 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-4757
Practice Address - Country:US
Practice Address - Phone:912-515-5869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy