Healthcare Provider Details

I. General information

NPI: 1043276819
Provider Name (Legal Business Name): PERFORMANCE MODALITIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19625 62ND AVE S SUITE A 101
KENT WA
98032-1103
US

IV. Provider business mailing address

19625 62ND AVE S SUITE A 101
KENT WA
98032-1106
US

V. Phone/Fax

Practice location:
  • Phone: 253-852-5612
  • Fax: 253-852-0427
Mailing address:
  • Phone: 253-852-5612
  • Fax: 253-852-0427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LUANA MICHELE HALL
Title or Position: MANAGER OF COMPLIANCE
Credential:
Phone: 206-569-4601