Healthcare Provider Details

I. General information

NPI: 1649678996
Provider Name (Legal Business Name): PERFORMANCE FOOT & ANKLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 WOOSTER RD
MILLERSBURG OH
44654-1033
US

IV. Provider business mailing address

890 WOOSTER RD
MILLERSBURG OH
44654-1033
US

V. Phone/Fax

Practice location:
  • Phone: 330-473-1447
  • Fax: 330-473-1520
Mailing address:
  • Phone: 330-473-1447
  • Fax: 330-473-1520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36.003427
License Number StateOH

VIII. Authorized Official

Name: NICOLE HORN
Title or Position: MEMBER
Credential: DPM
Phone: 330-473-1447