Healthcare Provider Details

I. General information

NPI: 1437659620
Provider Name (Legal Business Name): PERFORM PHYSIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 MCCARRELL LN
ZELIENOPLE PA
16063-2827
US

IV. Provider business mailing address

105 FAIRMONT DR
ZELIENOPLE PA
16063-1701
US

V. Phone/Fax

Practice location:
  • Phone: 724-831-8337
  • Fax:
Mailing address:
  • Phone: 724-831-8337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLEY ANN GREENAWALT
Title or Position: OWNER
Credential: PT, DPT, OCS, MTC
Phone: 724-831-8337