Provider Demographics
NPI:1255874871
Name:RETROFIT PERFORMANCE TRAINING LLC
Entity type:Organization
Organization Name:RETROFIT PERFORMANCE TRAINING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER - PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:806-674-5217
Mailing Address - Street 1:8123 FEWELL TRL
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-5858
Mailing Address - Country:US
Mailing Address - Phone:817-798-3198
Mailing Address - Fax:
Practice Address - Street 1:720 AIRPORT BLVD
Practice Address - Street 2:TRLR 71
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-4107
Practice Address - Country:US
Practice Address - Phone:806-674-5217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1263805261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy