Provider Demographics
NPI:1083455638
Name:PROACTIVE PHYSICAL THERAPY AND SPORTS PERFORMANCE LLC
Entity type:Organization
Organization Name:PROACTIVE PHYSICAL THERAPY AND SPORTS PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:660-973-7364
Mailing Address - Street 1:623 SOUTH WASHINGTON STREET
Mailing Address - Street 2:PO BOX 115
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601
Mailing Address - Country:US
Mailing Address - Phone:660-973-7364
Mailing Address - Fax:
Practice Address - Street 1:623 S WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601
Practice Address - Country:US
Practice Address - Phone:660-973-7364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy