Healthcare Provider Details

I. General information

NPI: 1619680105
Provider Name (Legal Business Name): POSITIVE PERFORMANCE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 UNIVERSITY DR STE 211
STATE COLLEGE PA
16801-6552
US

IV. Provider business mailing address

611 UNIVERSITY DR STE 211
STATE COLLEGE PA
16801-6552
US

V. Phone/Fax

Practice location:
  • Phone: 814-441-9183
  • Fax: 833-277-6195
Mailing address:
  • Phone: 814-441-9183
  • Fax: 833-277-6195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TRACI L RICHARDSON
Title or Position: OWNER
Credential: DPT
Phone: 814-441-9183