Basic Information
| Provider Information | |||||||||
| NPI: | 1295893816 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PERFORMANCE REHABILITATION PT PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 955 YONKERS AVE | ||||||||
| Address2: | SUITE 109 | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107043060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147767310 | ||||||||
| FaxNumber: | 9147767566 | ||||||||
| Practice Location | |||||||||
| Address1: | 1554 ASTOR AVE | ||||||||
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| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104696424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186523432 | ||||||||
| FaxNumber: | 7186525107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 06/15/2015 | ||||||||
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| AuthorizedOfficialLastName: | SREBNIK | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9147767310 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MS, PT, CHT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 009728 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.