Freedom Performance, LLC
Organization Active NPI Sports Physical Therapist · Prescott, AZ
NPI 1922778307 · NPPES record last updated Mar 14, 2023
Key facts
- NPI
- 1922778307
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Sports Physical Therapist 2251S0007X
- Legal business name
- FREEDOM PERFORMANCE, LLC
- Practice address
- 600 E Moeller St Ste 5
Prescott, AZ 86301-2692 - Phone
- (928) 420-3804
- NPI assigned
- Sep 16, 2021
- Organization subpart
- No
Authorized official
- Name
- Braden J Mengarelli
- Title
- Owner
- Phone
- (928) 440-7372
Practitioners 1
-
Braden J Mengarelli, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230508001596 | AZ | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 8022473461 |
Receives reassigned benefits from 1 practitioner Practice locations: Prescott, AZ |
National Provider Directory
Locations
600 E Moeller St
Ste 5
Prescott, AZ 86301
Phone (928) 420-3804
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physical Therapist |
2251S0007X | Yes |
Addresses
Primary practice location
600 E Moeller St Ste 5
Prescott, AZ 86301-2692
Mailing address
920 E Upper Sky Terrace Dr
Prescott, AZ 86303-5448
Phone (928) 420-3804
Other providers in Prescott, AZ
- Warisara Frechen
- Fred S Markham MD PC
- Jean Jauner Frederic
- Tracey Frederiksen
- Zoey L Freebairn
- Freedom Recovery Center, LLC.
- Austin Freeman
- Laurel Freeman
- Michael Adrian Frost
- Tammy Frost
All providers in Prescott, AZ · Sports Physical Therapist in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.