MEDICARE: PERFORMANCE REHAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MM18935	FL

General Provider Information

NPI Number	:	1043436561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE REHAB

Provider Business Mailing Address
First Line	:	721 SE 17TH ST
Second Line	:	STE 104
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2983
Country	:	US
Telephone Number	:	954-765-3200
Fax Number	:	954-765-3206

Provider Business Practice Location Address
First Line	:	2303 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6711
Country	:	US
Telephone Number	:	954-765-3200
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. BRIAN MEVORAH
Credential	:	DC
Telephone Number	:	954-765-3200

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/22/2020

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Directions to “PERFORMANCE REHAB ” Practice Location

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