Provider Demographics
NPI:1942939731
Name:PROFORMANCE THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:PROFORMANCE THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:256-203-3804
Mailing Address - Street 1:216 BEL AIR RD SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-3154
Mailing Address - Country:US
Mailing Address - Phone:256-203-3804
Mailing Address - Fax:256-513-9952
Practice Address - Street 1:1104 ANNIE RUTH JAMAR ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-4494
Practice Address - Country:US
Practice Address - Phone:256-203-3804
Practice Address - Fax:256-513-9952
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROFORMANCE THERAPY AND WELLNESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty