Healthcare Provider Details

I. General information

NPI: 1386550853
Provider Name (Legal Business Name): KISH PHYSICAL THERAPY AND PERFORMANCE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 BALCH RD
MADISON AL
35758-9715
US

IV. Provider business mailing address

305 WILLOW WOOD CT
MADISON AL
35758-6640
US

V. Phone/Fax

Practice location:
  • Phone: 904-386-4327
  • Fax:
Mailing address:
  • Phone: 904-386-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEVE LOGAN KISH
Title or Position: OWNER/ PHYSICAL THERAPIST
Credential: DPT
Phone: 904-386-4327