Organization
CHANGE THE GAME PERFORMANCE THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN GODFREY (OWNER)
(315) 292-8976
Entity
Organization
Contact information
Practice address
805 N 4TH ST, WILMINGTON, NC 28401-3471
(315) 292-8976
Mailing address
9080 SOUTHERN BLVD SE, WINNABOW, NC 28479-5016
(315) 292-8976
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
01/08/2024
Last updated
01/08/2024
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