Provider Demographics
NPI:1922778307
Name:FREEDOM PERFORMANCE, LLC
Entity Type:Organization
Organization Name:FREEDOM PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENGARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-440-7372
Mailing Address - Street 1:920 E UPPER SKY TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-5448
Mailing Address - Country:US
Mailing Address - Phone:928-420-3804
Mailing Address - Fax:
Practice Address - Street 1:600 E MOELLER ST STE 5
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2692
Practice Address - Country:US
Practice Address - Phone:928-420-3804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty