| Name: | Lifestyle & Performance Medicine, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 08 Jan 2016 (9 years ago) (Companies founded in January 2016) |
| Entity Number: | 000-355-633 |
| Register Number: | 000355633 |
| ZIP code: | 36535 (Companies in Baldwin, 36535) |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Registered Office Street Address: | 7823 STETE HWY 59 SOUTHFOLEY, AL 36535 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922451376 | 2016-07-21 | 2016-07-25 | 6506 N DAVIS HWY, PENSACOLA, FL, 325046957, US | 24847 COMMERCIAL AVE, ORANGE BEACH, AL, 365613845, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-889-0711 |
| Phone | +1 251-979-2067 |
Authorized person
| Name | SUSAN VEGA |
| Role | OFFICE CONTACT |
| Phone | 8508890711 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | MD34871 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAL LICENSE-FLORIDA |
| Number | PA9108469 |
| State | FL |
| Issuer | MEDICAL LICENSE-ALABAMA |
| Number | MD34871 |
| State | AL |
| Issuer | MEDICAL LICENSE-ALABAMA |
| Number | PA1108 |
| State | AL |
| Issuer | MEDICAL LICENSE-FLORIDA |
| Number | ME83357 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MOORE, T D | Agent | 158 CLUBHOUSE CIRCLEFAIRHOPE, AL 36532 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
