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General NPI Number Information
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NPI Number | 1669381885
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Entity Type | Organization
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Legal Business Name | PHYSIOLETE THERAPY AND PERFORMANCE LLC
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Dates
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Enumeration Date | 09/03/2026
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Last Update Date | 09/03/2026
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Provider Practice Location Address
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Address Line | 2625 COURTHOUSE CIR
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City | FLOWOOD
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State | MS
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Zip | 39232-9521
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Country | US
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Telephone | 769-208-3190
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Fax | 769-208-3191
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Provider Business Mailing Address
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Address Line | PO BOX 2862
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City | TUSCALOOSA
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State | AL
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Zip | 35403-2862
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Country | US
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Telephone | 205-409-8060
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Fax | 205-737-8841
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Authorized Official
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Title or Position | CO-OWNER
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Name | LAUREN C BUCKALEW
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Credential | DPT
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Telephone | 769-208-3190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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