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General NPI Number Information
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NPI Number | 1841736618
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Entity Type | Organization
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Legal Business Name | PROOF PHYSICAL THERAPY AND PERFORMANCE, LLC
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Dates
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Enumeration Date | 01/17/2017
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 460 N SWITZER CANYON DR STE 400
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-4851
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Country | US
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Telephone | 928-440-3106
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Fax | 928-438-6702
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Provider Business Mailing Address
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Address Line | 460 N SWITZER CANYON DR STE 400
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-4851
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Country | US
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Telephone | 928-440-3106
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Fax | 928-438-6702
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Authorized Official
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Title or Position | SOLE MEMBER, PHYSICAL THERAPIST
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Name | JORDAN WILLIAMS
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Credential |
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Telephone | 928-440-3106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 10915
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License Number State | AZ
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