Provider Demographics
NPI:1255068193
Name:DRIVE PHYSIOTHERAPY AND PERFORMANCE, LLC
Entity type:Organization
Organization Name:DRIVE PHYSIOTHERAPY AND PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WETHERALD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:252-574-6144
Mailing Address - Street 1:43 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-3715
Mailing Address - Country:US
Mailing Address - Phone:252-574-6144
Mailing Address - Fax:252-221-6290
Practice Address - Street 1:43 W 11TH ST
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-3715
Practice Address - Country:US
Practice Address - Phone:252-574-6144
Practice Address - Fax:252-221-6290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty