Healthcare Provider Details

I. General information

NPI: 1275838518
Provider Name (Legal Business Name): PERFORMANCE SPORTS MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13601 PRESTON RD STE. E525
DALLAS TX
75240-4911
US

IV. Provider business mailing address

P.O BOX 863268
PLANO TX
75086
US

V. Phone/Fax

Practice location:
  • Phone: 214-342-0400
  • Fax: 214-342-0406
Mailing address:
  • Phone: 214-342-0400
  • Fax: 214-342-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHERINE E. RENO
Title or Position: OWNER
Credential: M.D.
Phone: 214-342-0400