Healthcare Provider Details

I. General information

NPI: 1073630901
Provider Name (Legal Business Name): PERFORMANCE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3795 INDIAN HILL RD
SHRUB OAK NY
10588-1302
US

IV. Provider business mailing address

3795 INDIAN HILL RD
SHRUB OAK NY
10588-1302
US

V. Phone/Fax

Practice location:
  • Phone: 914-302-6415
  • Fax: 914-245-3905
Mailing address:
  • Phone: 914-302-6415
  • Fax: 914-245-3905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: TINA DEMPSEY
Title or Position: VP
Credential:
Phone: 914-302-6415