Healthcare Provider Details

I. General information

NPI: 1366987752
Provider Name (Legal Business Name): TRADEMARK PERFORMANCE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9145 W 103RD ST
SAINT JOHN IN
46373-8794
US

IV. Provider business mailing address

9145 W 103RD ST
SAINT JOHN IN
46373-8794
US

V. Phone/Fax

Practice location:
  • Phone: 517-425-2882
  • Fax:
Mailing address:
  • Phone: 517-425-2882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HORNBUCKLE
Title or Position: PRESIDENT
Credential:
Phone: 517-425-2882