Provider Demographics
NPI:1932968385
Name:PROACTIVE ALLIANCE THERAPY & WELLNESS, PLLC
Entity type:Organization
Organization Name:PROACTIVE ALLIANCE THERAPY & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:CLINTON
Authorized Official - Last Name:HAMRICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:731-335-2117
Mailing Address - Street 1:377 FANTASY LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1753
Mailing Address - Country:US
Mailing Address - Phone:731-335-2117
Mailing Address - Fax:
Practice Address - Street 1:181 HATCHER LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5987
Practice Address - Country:US
Practice Address - Phone:731-335-2117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty