Organization Name: | FL PERFORMANCE,LLC |
NPI Number: | 1326444795 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KIM FAGAN (OWNER/MEDICAL DIRECTOR) |
Mailing Address: | 3125 Independence Dr Suite 300a1 Homewood |
State: | AL US |
Postal Code: | 352094159 |
Phone Number: | 2058025949 |
Fax Number: | |
NPI Enumeration Date: | 11/13/2014 |
NPI Last Update Date: | 11/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 14105 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |