NPIMap

Organization Active NPI

Proimpact Physical Therapy & Sports Performance

  • Physical Therapist
  • Montgomery, AL
National Provider Identifier
1942580899
Registry record updated Aug 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PTH1388 Issued in AL
Legal business name
PROIMPACT PHYSICAL THERAPY & SPORTS PERFORMANCE
Practice address
5923 Monticello Dr
Montgomery, AL 36117-1940
Phone
(334) 356-6453
Fax
(334) 239-8126
NPI assigned
Aug 24, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2011

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

Authorized official

Name
Mr. Charles Michael Ellis, PT, ATCNPI 1134165343
Title
Owner
Phone
(334) 356-6453

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PTH1388 AL Primary

Addresses

Primary practice location

5923 Monticello Dr
Montgomery, AL 36117-1940

Mailing address

5923 Monticello Drive
Montgomery, AL 36117-1940
Phone (334) 356-6453

National Provider Directory

National Provider Directory
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.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1314144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314144000000",
    "number": "1942580899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5923 MONTICELLO DRIVE",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361171940",
            "telephone_number": "334-356-6453",
            "fax_number": "334-239-8126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5923 MONTICELLO DR",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361171940",
            "telephone_number": "334-356-6453",
            "fax_number": "334-239-8126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROIMPACT PHYSICAL THERAPY & SPORTS PERFORMANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-24",
        "last_updated": "2011-08-24",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "334-356-6453",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT, ATC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "AL",
            "license": "PTH1388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2011; 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.