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General NPI Number Information
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NPI Number | 1316375066
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Entity Type | Organization
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Legal Business Name | PERFORMANCE PT
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 6715 TIPPECANOE RD F101
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City | CANFIELD
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State | OH
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Zip | 44406-8180
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Country | US
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Telephone | 330-286-3669
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Fax |
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Provider Business Mailing Address
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Address Line | 6715 TIPPECANOE RD F101
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City | CANFIELD
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State | OH
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Zip | 44406-8180
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON MARUCCI
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Credential | D.C.
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Telephone | 330-286-3669
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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 | PT009320
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License Number State | OH
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