Provider Demographics
NPI:1679280267
Name:PREMIER PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC
Entity type:Organization
Organization Name:PREMIER PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:MAX EUGENE
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:620-338-8633
Mailing Address - Street 1:1909 N 14TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2365
Mailing Address - Country:US
Mailing Address - Phone:620-338-8633
Mailing Address - Fax:620-338-8121
Practice Address - Street 1:1909 N 14TH AVE STE C
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2365
Practice Address - Country:US
Practice Address - Phone:620-338-8633
Practice Address - Fax:620-338-8121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER PHYSICAL THERAPY AND SPORTS REHABILITATION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-02
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty