Healthcare Provider Details

I. General information

NPI: 1124402292
Provider Name (Legal Business Name): PERFORMANCE PHYSICAL THERAPY, INC. P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 OHIO ST
BELLINGHAM WA
98225-4637
US

IV. Provider business mailing address

420 OHIO ST
BELLINGHAM WA
98225-4637
US

V. Phone/Fax

Practice location:
  • Phone: 360-714-0870
  • Fax: 360-714-0872
Mailing address:
  • Phone: 360-714-0870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT00006136
License Number StateWA

VIII. Authorized Official

Name: MR. BRIAN JOSEPH WEEDA
Title or Position: OWNER
Credential: MSPTAT
Phone: 360-303-8420