Provider Demographics
NPI:1770872509
Name:IMPACT HEALTH AND PERFORMANCE, LLC
Entity type:Organization
Organization Name:IMPACT HEALTH AND PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:727-785-8737
Mailing Address - Street 1:180 ALT 19N
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5308
Mailing Address - Country:US
Mailing Address - Phone:727-785-8737
Mailing Address - Fax:727-786-8546
Practice Address - Street 1:180 ALT 19N
Practice Address - Street 2:SUITE B
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-5308
Practice Address - Country:US
Practice Address - Phone:727-785-8737
Practice Address - Fax:727-786-8546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy