Healthcare Provider Details

I. General information

NPI: 1104422732
Provider Name (Legal Business Name): JOINT PERFORMANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S DIXIE HWY STE 104
BOCA RATON FL
33432-6034
US

IV. Provider business mailing address

8238 NW 16TH ST
CORAL SPRINGS FL
33071-6215
US

V. Phone/Fax

Practice location:
  • Phone: 954-817-9864
  • Fax:
Mailing address:
  • Phone: 954-817-9864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251H1300X
TaxonomyHuman Factors Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CAMERON GORDON GORDON
Title or Position: CO-OWNER
Credential:
Phone: 954-817-9864