MEDICARE: REFINE PT AND PERFORMANCE - FOLEY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1598581225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REFINE PT AND PERFORMANCE - FOLEY LLC

Provider Business Mailing Address
First Line	:	108 S FLORIDA ST
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36606-1927
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	309 W LAUREL AVE
Second Line	:
City	:	FOLEY
State	:	AL
Zip	:	36535-1974
Country	:	US
Telephone Number	:	251-270-1551
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	KYLE THIBODEAUX
Credential	:
Telephone Number	:	251-501-2700

Provider Enumeration Date	:	11/26/2024
Last Update Date	:	11/26/2024

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