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General NPI Number Information
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NPI Number | 1255372256
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Entity Type | Organization
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Legal Business Name | PERFORMANCE PHYSICAL THERAPY OF PORT ORANGE
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 5100 S CLYDE MORRIS BLVD
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City | PORT ORANGE
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State | FL
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Zip | 32127-8976
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Country | US
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Telephone | 386-304-8112
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Fax |
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Provider Business Mailing Address
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Address Line | 5100 S CLYDE MORRIS BLVD SUITE 200
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City | PORT ORANGE
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State | FL
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Zip | 32127-8976
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Country | US
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Telephone | 386-304-8112
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | JAMES D JUDGE
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Credential | PT
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Telephone | 386-304-8112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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