Healthcare Provider Details

I. General information

NPI: 1407556061
Provider Name (Legal Business Name): WARRIOR PHYSICAL THERAPY AND PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2161 E WILLIAMS ST
APEX NC
27539-7714
US

IV. Provider business mailing address

2835 MILANO AVE
APEX NC
27502-9695
US

V. Phone/Fax

Practice location:
  • Phone: 949-705-7395
  • Fax:
Mailing address:
  • Phone: 949-705-7395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JACKSON DAVIS
Title or Position: OWNER
Credential: DPT
Phone: 949-705-7395