Provider Demographics
NPI:1235954108
Name:INVICTUS SMART PERFORMANCE, LLC
Entity type:Organization
Organization Name:INVICTUS SMART PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:479-799-0121
Mailing Address - Street 1:2086 JODECO RD # 1680
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5220
Mailing Address - Country:US
Mailing Address - Phone:678-827-2619
Mailing Address - Fax:
Practice Address - Street 1:1200 TOWN CENTER VILLAGE DR APT 1319
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5938
Practice Address - Country:US
Practice Address - Phone:479-799-0121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy