Pro Impact Physical Therapy and Sports Performance, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PTH1388 Issued in AL

Legal business name

PRO IMPACT PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC

Practice address

2000 Berry Chase PL
Montgomery, AL 36117-6896

Phone

(334) 356-6453

NPI assigned

Jul 13, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Charles Michael Ellis, P.T., ATCNPI 1134165343

Title

Physical Therapist

Phone

(334) 262-6161

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Tax ID family

Pro Impact Physical Therapy and Sports P2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Proimpact Physical Therapy & Sports Performance

  • Physical Therapist
  • Montgomery, AL
  • NPI 1942580899
  NPD tax ID

Locations

Practitioners 5

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

• Charles Michael Ellis, P.T., ATC

  • Physical Therapist
  • Montgomery, AL
  • NPI 1134165343
  Medicare reassignment Care Compare group NPD Authorized official
• Grayson Patrick Evans, PT,DPT

  • Physical Therapist
  • Montgomery, AL
  • NPI 1447042601
  Medicare reassignment Care Compare group NPD
• Danielle Kirkpatrick, PT

  • Physical Therapist
  • Montgomery, AL
  • NPI 1922484252
  Medicare reassignment Care Compare group NPD
• William Olsey

  • Physical Therapist
  • Montgomery, AL
  • NPI 1699294355
  Medicare reassignment Care Compare group NPD
• Julie Smith Moore, PT, DPT

  • Physical Therapist
  • Newnan, GA
  • NPI 1558758565

  AL

  Medicare reassignment NPD

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

{
    "created_epoch": "1247443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649030400000",
    "number": "1780813618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 242903",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361242903",
            "telephone_number": "334-356-6453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 BERRY CHASE PL",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361176896",
            "telephone_number": "334-356-6453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO IMPACT PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-13",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "334-262-6161",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T., ATC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "AL",
            "license": "PTH1388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Poe Prince, PHARMD
• Stacey M Pringle, MA
• Priority Virtual Healthcare, PLLC
• Christopher Pritchett, NP
• Dennis Pritzel, DPM
• Professional Pediatrics PA
• Progressivehealth, LLC
• Proimpact Physical Therapy & Sports Performance
• Project Wiggles & Giggles
• Matthew Provence Provence, DPT,PT

• Physical Therapist in Montgomery, AL
• Providers in Montgomery, AL by specialty
• Physical Therapist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.