Organization
BLACK WATCH SPORTS PERFORMANCE
Active
Organization
BLACK WATCH SPORTS PERFORMANCE
Active
Parent organization
BLACK WATCH SPORTS PERFORMANCE
Other names
BlackWatch Performance and Therapy
Organization subpart
Yes
Provider details
NPI number
Legal business name
BLACK WATCH SPORTS PERFORMANCE
Authorized official
SHELLEY ANNE ANDERSON DPT (PHYSICAL THERAPIST)
(229) 402-3338
Entity
Organization
Contact information
Practice address
157 RESOURCE CENTER PKWY STE 107, BIRMINGHAM, AL 35242-8135
(229) 402-3338
(205) 453-4603
Mailing address
157 RESOURCE CENTER PKWY STE 107, BIRMINGHAM, AL 35242-8135
(229) 402-3338
(205) 453-4603
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255980181
BLUE CROSS BLUE SHIELD
AL
Enumeration date
08/18/2021
Last updated
08/18/2021
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