1710102140 NPI number — PERFORMANCE PHYSICAL THERAPY INC

Table of content: (NPI 1710102140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710102140 NPI number — PERFORMANCE PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERFORMANCE PHYSICAL THERAPY 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:
PERFORMANCE PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
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:
1710102140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13704 HARVEST GLEN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20874-6250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-938-7915
Provider Business Mailing Address Fax Number:
410-431-7042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
877 BALTIMORE ANNAPOLIS BLVD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SEVERNA PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21146-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-431-7040
Provider Business Practice Location Address Fax Number:
410-431-7042
Provider Enumeration Date:
04/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PLACELLA
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
MARTIN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-938-7915

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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