# PRO IMPACT PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780813618
- **Authorized official:** MR. CHARLES MICHAEL ELLIS P.T., ATC (PHYSICAL THERAPIST)
- **Authorized official phone:** (334) 262-6161

## Contact information

- **Practice address:** 2000 BERRY CHASE PL, MONTGOMERY, AL 36117-6896
- **Practice address phone:** (334) 356-6453
- **Mailing address:** PO BOX 242903, MONTGOMERY, AL 36124-2903
- **Mailing address phone:** (334) 356-6453

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | PTH1388 | AL | Yes |

## Other

- **Enumeration date:** 07/13/2009
- **Last updated:** 04/04/2022