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General NPI Number Information
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NPI Number | 1295696185
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Entity Type | Organization
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Legal Business Name | PRIMAL RECOVERY PT & PERFORMANCE
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Dates
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Enumeration Date | 11/20/2025
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 36600 PLYMOUTH RD
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City | LIVONIA
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State | MI
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Zip | 48150-1127
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Country | US
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Telephone | 248-814-2029
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Fax |
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Provider Business Mailing Address
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Address Line | 36600 PLYMOUTH RD
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City | LIVONIA
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State | MI
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Zip | 48150-1127
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | ZACHARY ATWOOD
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Credential | DPT
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Telephone | 248-814-2029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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