Provider Demographics
NPI:1104412964
Name:ARTEMIS PERFORMANCE & PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ARTEMIS PERFORMANCE & PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:605-201-0609
Mailing Address - Street 1:2472 RUE BIENVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044
Mailing Address - Country:US
Mailing Address - Phone:605-201-0609
Mailing Address - Fax:
Practice Address - Street 1:2472 RUE BIENVILLE WAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044
Practice Address - Country:US
Practice Address - Phone:605-201-0609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy