Impact Physical Therapy, PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

IMPACT PHYSICAL THERAPY, PLLC

Doing business as

Impact Physical Therapy and Athletic Performance

Practice address

843 Fairview Ave Ste B5
Bowling Green, KY 42101-4975

Phone

(601) 502-3765

NPI assigned

Jun 10, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Wesley Lawless, DPT, CSCSNPI 1104431972

Title

Owner

Phone

(601) 502-3765

Specialties & licenses 1

Addresses

Other names 1

• Impact Physical Therapy and Athletic Performance Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wesley Lawless, DPT

  • Physical Therapist
  • Bowling Green, KY
  • NPI 1104431972
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1306688320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1135 ANGELICA ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421045594",
            "telephone_number": "601-502-3765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "843 FAIRVIEW AVE STE B5",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421014975",
            "telephone_number": "601-502-3765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A",
        "authorized_official_last_name": "LAWLESS",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-502-3765",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT, CSCS"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Impact Physical Therapy and Athletic Performance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Troy Dell Hyman, CST/CFA
• Caylee Hymer, CCC-SLP
• Eme O Igbokwe, M.D.
• Sardar Hassan Ijaz, MD
• Louis Ilenga
• In His Image LLC
• Indar M. Jhamb, M.D.
• Jessica C Ingram, NP-C
• Insight Psychiatry Center LLC
• Integrated Therapy Associates, LLC

• Physical Therapy Clinic/Center in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Physical Therapy Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.