Basic Information
| Provider Information | |||||||||
| NPI: | 1780104679 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PERFORMANCE THERAPEUTICS - SAN ANTONIO PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PERFORMANCE THERAPEUTICS-SAN ANTONIO | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 N 23RD ST | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785016127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566874555 | ||||||||
| FaxNumber: | 9566874554 | ||||||||
| Practice Location | |||||||||
| Address1: | 7220 LOUIS PASTEUR | ||||||||
| Address2: | SUITE 144 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782294534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102909335 | ||||||||
| FaxNumber: | 2102909623 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2017 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | CANALES | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 9566874559 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.