Healthcare Provider Details

I. General information

NPI: 1699292201
Provider Name (Legal Business Name): PERFORMANCE & RECOVERY LAB, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3514 N POWER RD STE 133
MESA AZ
85215-2911
US

IV. Provider business mailing address

3514 N POWER RD STE 133
MESA AZ
85215-2911
US

V. Phone/Fax

Practice location:
  • Phone: 480-625-6693
  • Fax: 480-304-3269
Mailing address:
  • Phone: 480-625-6693
  • Fax: 480-304-3269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number10208
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1407293491
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerINDIVIDUAL NPI

VIII. Authorized Official

Name: COURTNEY WARREN
Title or Position: OWNER
Credential: DPT
Phone: 702-443-1133