| Name: | Physiolete Therapy and Performance LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 09 Jan 2019 (6 years ago) |
| Entity Number: | 000-539-098 |
| Register Number: | 000539098 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Registered Office Street Address: | 4841 COPPER LOOP ROADNORTHPORT, AL 35473 |
| Registered Office Street Address ZIP Code: | 35473 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275187650 | 2019-07-24 | 2019-07-24 | 610 LURLEEN B WALLACE BLVD N, TUSCALOOSA, AL, 354011713, US | 610 LURLEEN B WALLACE BLVD N, TUSCALOOSA, AL, 354011713, US | |||||||||||||
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| Phone | +1 205-292-2428 |
Authorized person
| Name | MICHELLE HAWTHORNE |
| Role | CREDENTIALING COORDINATOR |
| Phone | 2052922428 |
Taxonomy
| Taxonomy Code | 261QP2000X - Physical Therapy Clinic/Center |
| Is Primary | Yes |
| Name | Role |
|---|---|
| BUCKALEW, LAUREN BUCKALEW | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
