Healthcare Provider Details

I. General information

NPI: 1881894103
Provider Name (Legal Business Name): PERFORMANCE PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ROBB DR SUITE 103
RENO NV
89523-2524
US

IV. Provider business mailing address

720 ROBB DR SUITE 103
RENO NV
89523-2524
US

V. Phone/Fax

Practice location:
  • Phone: 775-787-3733
  • Fax:
Mailing address:
  • Phone: 775-787-3733
  • Fax: 775-787-3744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number496
License Number StateNV

VIII. Authorized Official

Name: KIRK JEFFERSON SACHTLER
Title or Position: PRESIDENT
Credential: DPT
Phone: 775-787-3733