Healthcare Provider Details

I. General information

NPI: 1184542698
Provider Name (Legal Business Name): STRADA PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 MESA CANYON DR
IDAHO FALLS ID
83401-6518
US

IV. Provider business mailing address

1917 MESA CANYON DR
IDAHO FALLS ID
83401-6518
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-9278
  • Fax:
Mailing address:
  • Phone: 904-383-9278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: COLBY EBANKS
Title or Position: OWNER
Credential: PT, DPT
Phone: 904-383-9278