MEDICARE: PERFORMANCE PLUS PHYSICAL THERAPY, INC.

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	225100000X	Physical Therapist	30298	CA

General Provider Information

NPI Number	:	1144766064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE PLUS PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	1392 E PALOMAR ST STE 503
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91913-1895
Country	:	US
Telephone Number	:	619-482-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1392 E PALOMAR ST STE 503
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91913-1895
Country	:	US
Telephone Number	:	619-482-3000
Fax Number	:	619-482-3001

Authorized Official
Title or Position	:	OWNER/ PRESIDENT
Name	:	TODD MICHAEL SPARKS
Credential	:	PT, DPT, OCS, CSCS
Telephone Number	:	858-336-0163

Provider Enumeration Date	:	01/17/2017
Last Update Date	:	03/23/2021

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