Healthcare Provider Details

I. General information

NPI: 1720387632
Provider Name (Legal Business Name): PERFORMANCE SPINE & SPORTS PHYSICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 W GERMANTOWN PIKE
EAST NORRITON PA
19403-4260
US

IV. Provider business mailing address

342 W GERMANTOWN PIKE
EAST NORRITON PA
19403-4260
US

V. Phone/Fax

Practice location:
  • Phone: 610-275-7013
  • Fax: 610-275-7015
Mailing address:
  • Phone: 610-275-7013
  • Fax: 610-275-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StatePA

VIII. Authorized Official

Name: GREGORY J. CHAPIS
Title or Position: OWNER
Credential: MD
Phone: 610-970-4700