Organization
PROIMPACT PHYSICAL THERAPY & SPORTS PERFORMANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES MICHAEL ELLIS PT, ATC (OWNER)
(334) 356-6453
Entity
Organization
Contact information
Practice address
5923 MONTICELLO DR, MONTGOMERY, AL 36117-1940
(334) 356-6453
(334) 239-8126
Mailing address
5923 MONTICELLO DRIVE, MONTGOMERY, AL 36117-1940
(334) 356-6453
(334) 239-8126
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH1388
AL
Other
Enumeration date
08/24/2011
Last updated
08/24/2011
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