1164790770 NPI number — PERFORMANCE MODALITIES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164790770 NPI number — PERFORMANCE MODALITIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERFORMANCE MODALITIES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164790770
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19625 62ND AVE S
Provider Second Line Business Mailing Address:
SUITE A101
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98032-1103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-852-5612
Provider Business Mailing Address Fax Number:
253-852-0427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 17TH AVE
Provider Second Line Business Practice Location Address:
SUITE A30
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98122-5711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-329-0403
Provider Business Practice Location Address Fax Number:
206-329-0407
Provider Enumeration Date:
12/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
LUANA
Authorized Official Middle Name:
MICHELE
Authorized Official Title or Position:
DIRECTOR OF COMPLIANCE
Authorized Official Telephone Number:
206-569-4601

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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