MEDICARE: COMMITTED PERFORMANCE 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	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1649670621	OTHER		NPI TYPE 1

General Provider Information

NPI Number	:	1689257776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMITTED PERFORMANCE LLC

Provider Business Mailing Address
First Line	:	4100 RED ROCK WAY
Second Line	:
City	:	PLEASANT GROVE
State	:	AL
Zip	:	35127-3520
Country	:	US
Telephone Number	:	205-317-8172
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 RED ROCK WAY
Second Line	:
City	:	PLEASANT GROVE
State	:	AL
Zip	:	35127-3520
Country	:	US
Telephone Number	:	205-317-8172
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	JOHNITIA DYANNE WILLIAMS
Credential	:	DPT
Telephone Number	:	205-317-8172

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	05/05/2021

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Directions to “COMMITTED PERFORMANCE LLC ” Practice Location

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