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General NPI Number Information
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NPI Number | 1275014938
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Entity Type | Organization
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Legal Business Name | DISTRICT PERFORMANCE & PHYSIO
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 1722 EYE ST NW BSMT LEVEL
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City | WASHINGTON
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State | DC
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Zip | 20006-3710
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Country | US
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Telephone | 202-922-7331
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 TUNLAW RD NW APT 1021
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City | WASHINGTON
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State | DC
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Zip | 20007-4845
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Country | US
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Telephone | 607-768-3540
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSE LEWIS
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Credential | PT
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Telephone | 607-768-3540
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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 | PT871842
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License Number State | DC
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