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General NPI Number Information
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NPI Number | 1184595738
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Entity Type | Organization
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Legal Business Name | PERFORMANCE ORTHOPEDIC DESIGN LLC
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Dates
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Enumeration Date | 09/16/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 193 TILLEY DR STE 103
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-4440
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Country | US
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Telephone | 518-324-6569
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Fax | 518-324-6570
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Provider Business Mailing Address
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Address Line | 7 OLD MILITARY RD
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City | LAKE PLACID
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State | NY
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Zip | 12946-1614
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Country | US
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Telephone | 518-324-6569
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Fax | 518-324-6570
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | BRITTANY ANNE WILLIAMS
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Credential |
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Telephone | 518-324-6569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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