Healthcare Provider Details

I. General information

NPI: 1700244878
Provider Name (Legal Business Name): PERFORMANCE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 HIGHWAY 16 E
CARTHAGE MS
39051-4220
US

IV. Provider business mailing address

1018 HIGHWAY 16 E
CARTHAGE MS
39051-4220
US

V. Phone/Fax

Practice location:
  • Phone: 601-267-3241
  • Fax:
Mailing address:
  • Phone: 601-267-3241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT5901
License Number StateMS

VIII. Authorized Official

Name: DEBORAH YOUNG
Title or Position: OFFICE MANAGER
Credential:
Phone: 601-267-3241