Healthcare Provider Details

I. General information

NPI: 1295696185
Provider Name (Legal Business Name): PRIMAL RECOVERY PT & PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36600 PLYMOUTH RD
LIVONIA MI
48150-1127
US

IV. Provider business mailing address

36600 PLYMOUTH RD
LIVONIA MI
48150-1127
US

V. Phone/Fax

Practice location:
  • Phone: 248-814-2029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY ATWOOD
Title or Position: FOUNDER
Credential: DPT
Phone: 248-814-2029