Basic Information
| Provider Information | |||||||||
| NPI: | 1275123283 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PERFORMANCE PHYSIO, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2315 E 35TH AVE | ||||||||
| Address2: | |||||||||
| City: | APACHE JUNCTION | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851193690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804108780 | ||||||||
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| Practice Location | |||||||||
| Address1: | MOBILE SERVICE/HOUSE CALLS | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804108780 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2021 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | HANNA | ||||||||
| AuthorizedOfficialFirstName: | SARAH | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4804108780 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | PT, MPT, FAAOMPT | ||||||||
| NPICertificationDate: | 01/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.