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General NPI Number Information
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NPI Number | 1104230028
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Entity Type | Organization
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Legal Business Name | PERFORMANCE PLUS PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/18/2014
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Last Update Date | 06/18/2014
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Provider Practice Location Address
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Address Line | 1712 I ST NW SUITE 305
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City | WASHINGTON
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State | DC
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Zip | 20006-3702
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Country | US
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Telephone | 410-499-9512
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Fax |
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Provider Business Mailing Address
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Address Line | 7333 NEW HAMPSHIRE AVE APT 414S
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City | TAKOMA PARK
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State | MD
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Zip | 20912-6958
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Country | US
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Telephone | 410-499-9512
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANELLE DICKSON
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Credential | PT DPT OCA
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Telephone | 410-499-9512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT870773
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License Number State | DC
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