Healthcare Provider Details

I. General information

NPI: 1275123283
Provider Name (Legal Business Name): PERFORMANCE PHYSIO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21575 E MAYA RD
QUEEN CREEK AZ
85142-5570
US

IV. Provider business mailing address

21575 E MAYA RD
QUEEN CREEK AZ
85142-5570
US

V. Phone/Fax

Practice location:
  • Phone: 480-410-8780
  • Fax:
Mailing address:
  • Phone: 480-410-8780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SARAH POWELL
Title or Position: OWNER
Credential:
Phone: 480-410-8780