Organization
INFINITY FUNCTIONAL PERFORMANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN EUGENE COCHRANE APRN, CRNA (MANAGING MEMBER)
(530) 300-3852
Entity
Organization
Contact information
Practice address
161 SUMMIT AVE STE 100, SOUTHLAKE, TX 76092-6470
(877) 533-5125
Mailing address
161 SUMMIT AVE STE 100, SOUTHLAKE, TX 76092-6470
(530) 300-3852
(972) 908-0069
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
133N00000X
Nutritionist
—
—
133V00000X
Registered Dietitian
—
—
163W00000X
Registered Nurse
—
—
208600000X
Surgery Physician
—
—
225100000X
Physical Therapist
—
—
363L00000X
Nurse Practitioner
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
12/19/2020
Last updated
04/03/2023
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