Basic Information
| Provider Information | |||||||||
| NPI: | 1932334075 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PERFORMANCE THERAPEUTICS-WESLACO, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 LINDBERG AVE | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785012924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566874560 | ||||||||
| FaxNumber: | 9566181342 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 E 8TH ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | WESLACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785967111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566874560 | ||||||||
| FaxNumber: | 9566181342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2009 | ||||||||
| LastUpdateDate: | 05/19/2009 | ||||||||
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| AuthorizedOfficialLastName: | PALOMIN | ||||||||
| AuthorizedOfficialFirstName: | OMAR | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 9566874560 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.