MEDICARE: PERFORMANCE REHAB INSTITUTE & SPORTS MEDICINE, 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	261QP2000X	Physical Therapy Clinic/Center		FL

General Provider Information

NPI Number	:	1437264520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE REHAB INSTITUTE & SPORTS MEDICINE, INC.

Provider Business Mailing Address
First Line	:	3450 E LAKE RD
Second Line	:	SUITE 101
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2411
Country	:	US
Telephone Number	:	727-781-1223
Fax Number	:	727-772-1161

Provider Business Practice Location Address
First Line	:	3450 E LAKE RD
Second Line	:	SUITE 101
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2411
Country	:	US
Telephone Number	:	727-781-1223
Fax Number	:	727-772-1161

Authorized Official
Title or Position	:	OWNER
Name	:	MR. TODD SCOTT MINEAR
Credential	:	P.T.
Telephone Number	:	727-781-1223

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	08/22/2020

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