Provider Demographics
NPI:1679283188
Name:FREEDOM PHYSICAL THERAPY & PERFORMANCE
Entity type:Organization
Organization Name:FREEDOM PHYSICAL THERAPY & PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-808-1913
Mailing Address - Street 1:1876 N MARKETSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-5493
Mailing Address - Country:US
Mailing Address - Phone:217-808-1913
Mailing Address - Fax:
Practice Address - Street 1:1876 N MARKETSIDE AVE
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-5493
Practice Address - Country:US
Practice Address - Phone:217-808-1913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy