Basic Information
| Provider Information | |||||||||
| NPI: | 1700244878 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PERFORMANCE THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1018 HIGHWAY 16 E | ||||||||
| Address2: | |||||||||
| City: | CARTHAGE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390514220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012673241 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1018 HIGHWAY 16 E | ||||||||
| Address2: | |||||||||
| City: | CARTHAGE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390514220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012673241 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2016 | ||||||||
| LastUpdateDate: | 02/04/2016 | ||||||||
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| AuthorizedOfficialLastName: | YOUNG | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6012673241 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | PT5901 | MS | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.