Healthcare Provider Details

I. General information

NPI: 1821342346
Provider Name (Legal Business Name): PERFORMANCE REHAB ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S KINGS DR SUITE F
CHARLOTTE NC
28204-3089
US

IV. Provider business mailing address

601 S KINGS DR SUITE F
CHARLOTTE NC
28204-3089
US

V. Phone/Fax

Practice location:
  • Phone: 980-819-8020
  • Fax: 980-819-8545
Mailing address:
  • Phone: 980-819-8020
  • Fax: 980-819-8545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN J CIPRIANI
Title or Position: PRESIDENT
Credential: D.C.
Phone: 980-819-8020