Healthcare Provider Details

I. General information

NPI: 1710254669
Provider Name (Legal Business Name): PERFORMANCE PODIATRY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N F ST
HAMILTON OH
45013-3075
US

IV. Provider business mailing address

10475 READING RD SUITE 404
CINCINNATI OH
45241-2563
US

V. Phone/Fax

Practice location:
  • Phone: 513-563-6228
  • Fax: 513-577-7261
Mailing address:
  • Phone: 513-563-6228
  • Fax: 513-577-7261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36003134
License Number StateOH

VIII. Authorized Official

Name: DR. RODNEY W ROOF
Title or Position: PRESDIENT
Credential: DPM
Phone: 513-563-6228