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General NPI Number Information
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NPI Number | 1194710582
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Entity Type | Organization
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Legal Business Name | PERFORMAX PHYSICAL THERAPY & REHABILITATION PC
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 40 SAW MILL RIVER RD
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City | HAWTHORNE
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State | NY
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Zip | 10532-1535
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Country | US
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Telephone | 914-345-8080
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Fax | 914-345-8082
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Provider Business Mailing Address
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Address Line | 40 SAW MILL RIVER RD
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City | HAWTHORNE
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State | NY
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Zip | 10532-1535
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Country | US
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Telephone | 914-345-8080
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Fax | 914-345-8082
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Authorized Official
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Title or Position | DIRECTOR
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Name | DANA SULLIVAN
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Credential | PT
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Telephone | 914-345-8080
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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 |
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License Number State |
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