Provider Demographics
NPI:1740006782
Name:EXOS AP ARIZONA, LLC
Entity type:Organization
Organization Name:EXOS AP ARIZONA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GODIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:207-232-8692
Mailing Address - Street 1:4113 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-3917
Mailing Address - Country:US
Mailing Address - Phone:470-508-0510
Mailing Address - Fax:
Practice Address - Street 1:4113 LAKE ST
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-3917
Practice Address - Country:US
Practice Address - Phone:470-508-0510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHLETES' PERFORMANCE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy