Organization
PRO IMPACT PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES MICHAEL ELLIS P.T., ATC (PHYSICAL THERAPIST)
(334) 262-6161
Entity
Organization
Contact information
Practice address
2000 BERRY CHASE PL, MONTGOMERY, AL 36117-6896
(334) 356-6453
Mailing address
PO BOX 242903, MONTGOMERY, AL 36124-2903
(334) 356-6453
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH1388
AL
Other
Enumeration date
07/13/2009
Last updated
04/04/2022
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