=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407565161
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POWERMILL PERFORMANCE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2022
-----------------------------------------------------
Last Update Date | 11/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 OVERTON RIDGE CIR # US
-----------------------------------------------------
City | WEATHERFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76088-7847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-472-9598
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 OVERTON RIDGE CIR # US
-----------------------------------------------------
City | WEATHERFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76088-7847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-472-9598
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF PHYSICAL THERAPY
-----------------------------------------------------
Name | AARON ROSS MILLER
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 716-472-9598
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------