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General NPI Number Information
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NPI Number | 1003693029
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Entity Type | Organization
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Legal Business Name | ATHLETIC EDGE PERFORMANCE
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 11/01/2025
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Provider Practice Location Address
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Address Line | 2531 CENTER WEST PARKWAY BUILDING 100, SUITE 700
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City | AUGUSTA
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State | GA
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Zip | 30909-2141
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Country | US
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Telephone | 770-652-7477
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Fax | 762-218-2938
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Provider Business Mailing Address
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Address Line | 4043 FIELDCREST DR
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City | NORTH AUGUSTA
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State | SC
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Zip | 29841-0145
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Country | US
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Telephone | 770-652-7477
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AUSTIN SHELNUTT
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Credential | PT
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Telephone | 770-652-7477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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