Healthcare Provider Details

I. General information

NPI: 1528176419
Provider Name (Legal Business Name): PERFORMANCE PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25864 BUSINESS CENTER DR STE C
REDLANDS CA
92374-4515
US

IV. Provider business mailing address

PO BOX 847
REDLANDS CA
92373-0261
US

V. Phone/Fax

Practice location:
  • Phone: 909-796-7700
  • Fax: 909-796-4384
Mailing address:
  • Phone: 909-796-7700
  • Fax: 909-796-4384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER CHRISTOPHER LINGAS
Title or Position: PRESIDENT
Credential: DPT, OCS, SCS
Phone: 909-796-7700