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General NPI Number Information
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NPI Number | 1376860585
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Entity Type | Organization
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Legal Business Name | PRIMO PERFORMANCE AND REHABILITATION, INC.
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Dates
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Enumeration Date | 04/27/2010
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Last Update Date | 04/27/2010
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Provider Practice Location Address
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Address Line | 300 BOWIE ST #706
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City | AUSTIN
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State | TX
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Zip | 78703-4661
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Country | US
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Telephone | 619-944-5561
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Fax |
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Provider Business Mailing Address
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Address Line | 300 BOWIE ST #706
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City | AUSTIN
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State | TX
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Zip | 78703-4661
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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 | PRESIDENT, PHYSICAL THERAPIST
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Name | DR. JESSICA MARIE TRANCHINA
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Credential | P.T, D.P.T.
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Telephone | 619-944-5561
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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 | 1158248
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License Number State | TX
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