Provider Demographics
NPI:1417724451
Name:OUTLAW PHYSIO LLC
Entity type:Organization
Organization Name:OUTLAW PHYSIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:TRUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:760-500-3575
Mailing Address - Street 1:4211 LENNOX DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4550
Mailing Address - Country:US
Mailing Address - Phone:760-500-3575
Mailing Address - Fax:
Practice Address - Street 1:4211 LENNOX DR
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-4550
Practice Address - Country:US
Practice Address - Phone:760-500-3575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy