Provider Demographics
NPI:1649853086
Name:ACTIVATED PERFORMANCE LLC
Entity type:Organization
Organization Name:ACTIVATED PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-440-7187
Mailing Address - Street 1:14190 XENON ST NW UNIT 8
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-9134
Mailing Address - Country:US
Mailing Address - Phone:612-440-7187
Mailing Address - Fax:
Practice Address - Street 1:34 13TH AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1002
Practice Address - Country:US
Practice Address - Phone:612-378-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty