# PROIMPACT PHYSICAL THERAPY & SPORTS PERFORMANCE

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

## Provider details

- **NPI number:** 1942580899
- **Authorized official:** MR. CHARLES MICHAEL ELLIS PT, ATC (OWNER)
- **Authorized official phone:** (334) 356-6453

## Contact information

- **Practice address:** 5923 MONTICELLO DR, MONTGOMERY, AL 36117-1940
- **Practice address phone:** (334) 356-6453
- **Practice address fax:** (334) 239-8126
- **Mailing address:** 5923 MONTICELLO DRIVE, MONTGOMERY, AL 36117-1940
- **Mailing address phone:** (334) 356-6453
- **Mailing address fax:** (334) 239-8126

## Taxonomy

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

## Other

- **Enumeration date:** 08/24/2011
- **Last updated:** 08/24/2011