Healthcare Provider Details

I. General information

NPI: 1801085071
Provider Name (Legal Business Name): PERFORMANCE MODALITIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 YAKIMA AVE STE 200
TACOMA WA
98405-4499
US

IV. Provider business mailing address

19625 62ND AVE S STE A101
KENT WA
98032-1106
US

V. Phone/Fax

Practice location:
  • Phone: 866-687-4463
  • Fax: 877-414-2727
Mailing address:
  • Phone: 866-687-4463
  • Fax: 877-414-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number601 488 099
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

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