Black Watch Sports Performance

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

BLACK WATCH SPORTS PERFORMANCE

Doing business as

BlackWatch Performance and Therapy

Practice address

157 Resource Center Pkwy Ste 107
Birmingham, AL 35242-8135

Phone

(229) 402-3338

Fax

(205) 453-4603

NPI assigned

Aug 18, 2021

Organization subpart

Yes

Parent organization

BLACK WATCH SPORTS PERFORMANCEAs reported in NPPES

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

Authorized official

Name

Shelley Anne Anderson, DPTNPI 1255980181

Title

Physical Therapist

Phone

(229) 402-3338

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• BlackWatch Performance and Therapy Doing business as

Part of

Black Watch Sports Performance

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shelley Anne Anderson, PT, DPT

  • Physical Therapist
  • Birmingham, AL
  • NPI 1255980181
  NPD Authorized official

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

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629244800000",
    "number": "1730855016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "157 RESOURCE CENTER PKWY STE 107",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352428135",
            "telephone_number": "229-402-3338",
            "fax_number": "205-453-4603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 RESOURCE CENTER PKWY STE 107",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352428135",
            "telephone_number": "229-402-3338",
            "fax_number": "205-453-4603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK WATCH SPORTS PERFORMANCE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLACK WATCH SPORTS PERFORMANCE",
        "enumeration_date": "2021-08-18",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "229-402-3338",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1255980181",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BlackWatch Performance and Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eric Michael Bixby, MD
• Erica Christen Bjornstad, MD
• BKD Alabama SNF LLC (Brookdale University Park SNF (AL))
• BKD Personal Assistance Services LLC (Brookdale at Home University Park)
• Black Box Diagnostics
• Allison Black, M.D.
• Breana Whitten Black, AGACNP-BC
• Cassidy Ann Black, CRNP
• David Christopher Black, M.D.
• Jonathan Andrew Black, MD

• Physical Therapy Clinic/Center in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Physical Therapy Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; 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.