Healthcare Provider Details

I. General information

NPI: 1982344578
Provider Name (Legal Business Name): PERFORMANCE STRENGTH CHIROPRACTIC & PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77A ROUTE 25A
ROCKY POINT NY
11778-8881
US

IV. Provider business mailing address

77A ROUTE 25A
ROCKY POINT NY
11778-8881
US

V. Phone/Fax

Practice location:
  • Phone: 631-849-6363
  • Fax: 631-849-6361
Mailing address:
  • Phone: 631-849-6363
  • Fax: 631-849-6361

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. ROBERTA LYNN PEETS
Title or Position: PARTNER
Credential: DC
Phone: 631-849-6363