Healthcare Provider Details

I. General information

NPI: 1225073877
Provider Name (Legal Business Name): PERFORMANCE SPINE AND SPORTS PHYSICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 E HIGH ST SUITE C
POTTSTOWN PA
19464-5061
US

IV. Provider business mailing address

1603 E HIGH ST SUITE C
POTTSTOWN PA
19464-5061
US

V. Phone/Fax

Practice location:
  • Phone: 610-970-4700
  • Fax: 610-970-5635
Mailing address:
  • Phone: 610-970-4700
  • Fax: 610-970-5635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier001720015-0002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier001720015-0004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

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