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NPI Code Detail

MEDICARE: PERFORMANCE PHYSICAL THERAPY & WELLNESS LLC

MEDICARE: PERFORMANCE PHYSICAL THERAPY & WELLNESS LLC
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
1225100000XPhysical Therapist11545OH

General Provider Information

NPI Number : 1760815559
Entity Type Code : Organization
Provider Name (Legal Business Name) : PERFORMANCE PHYSICAL THERAPY & WELLNESS LLC
Provider Business Mailing Address
First Line : 216 W MAIN ST
Second Line :
City : COLDWATER
State : OH
Zip : 45828-1703
Country : US
Telephone Number : 419-763-1464
Fax Number : 419-763-1482
Provider Business Practice Location Address
First Line : 216 W MAIN ST
Second Line :
City : COLDWATER
State : OH
Zip : 45828-1703
Country : US
Telephone Number : 419-763-1464
Fax Number : 419-763-1482
Authorized Official
Title or Position : PT
Name : JACQUELYN BROERING
Credential : PT
Telephone Number : 567-644-9073
Provider Enumeration Date : 08/15/2013
Last Update Date : 09/07/2021

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Directions to “PERFORMANCE PHYSICAL THERAPY & WELLNESS LLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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