Healthcare Provider Details

I. General information

NPI: 1881034692
Provider Name (Legal Business Name): PERFORMA REHAB SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 08/17/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 E MAIN ST.
MELBOURNE AR
72556
US

IV. Provider business mailing address

PO BOX 617
MELBOURNE AR
72556-0617
US

V. Phone/Fax

Practice location:
  • Phone: 901-800-8512
  • Fax:
Mailing address:
  • Phone: 870-368-3020
  • Fax: 870-368-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateAR

VIII. Authorized Official

Name: MR. CHRISTOPHER DAVID MONROE
Title or Position: OWNER/CEO
Credential:
Phone: 901-800-8512