Healthcare Provider Details

I. General information

NPI: 1578719761
Provider Name (Legal Business Name): PERFORMANCE PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 RIVER RD SUITE B
EUGENE OR
97404-3230
US

IV. Provider business mailing address

1000 RIVER RD SUITE B
EUGENE OR
97404-3230
US

V. Phone/Fax

Practice location:
  • Phone: 541-689-0935
  • Fax: 541-461-6884
Mailing address:
  • Phone: 541-689-0935
  • Fax: 541-461-6884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GLENDA L PATTON
Title or Position: OWNER
Credential: P.T.
Phone: 541-689-0935