=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245737303
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VPT PERFORMANCE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2018
-----------------------------------------------------
Last Update Date | 06/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 INDUSTRIAL PARK DR
-----------------------------------------------------
City | SODDY DAISY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37379-4224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-815-2722
-----------------------------------------------------
Fax | 423-815-2722
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 INDUSTRIAL PARK DR
-----------------------------------------------------
City | SODDY DAISY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37379-4224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | JOSEPH FANELLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 423-815-2722
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------