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General NPI Number Information
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NPI Number | 1922778307
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Entity Type | Organization
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Legal Business Name | FREEDOM PERFORMANCE, LLC
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 600 E MOELLER ST STE 5
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City | PRESCOTT
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State | AZ
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Zip | 86301-2692
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Country | US
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Telephone | 928-420-3804
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Fax |
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Provider Business Mailing Address
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Address Line | 920 E UPPER SKY TERRACE DR
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City | PRESCOTT
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State | AZ
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Zip | 86303-5448
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Country | US
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Telephone | 928-420-3804
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRADEN J MENGARELLI
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Credential |
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Telephone | 928-440-7372
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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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