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General NPI Number Information
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NPI Number | 1770064990
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Entity Type | Organization
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Legal Business Name | PROFORMANCE THERAPY AND WELLNESS LLC
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Dates
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Enumeration Date | 08/25/2018
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 162 EXPORT CIR NW
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City | HUNTSVILLE
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State | AL
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Zip | 35806-3916
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Country | US
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Telephone | 256-203-3804
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Fax | 256-513-9952
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Provider Business Mailing Address
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Address Line | 216 BEL AIR RD SE
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City | HUNTSVILLE
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State | AL
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Zip | 35802-3154
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Country | US
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Telephone | 256-203-3804
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Fax | 256-513-9952
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAGGIE ANN DUGGAN
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Credential | DPT
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Telephone | 706-410-0255
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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 | PTH6560
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License Number State | AL
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