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General NPI Number Information
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NPI Number | 1548279565
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Entity Type | Organization
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Legal Business Name | PERFORMANCE THERAPEUTICS MISSION
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 1317 ST CLAIRE BLVD STE A
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City | MISSION
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State | TX
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Zip | 78572-6636
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Country | US
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Telephone | 956-584-3535
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 N 23RD ST
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City | MCALLEN
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State | TX
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Zip | 78501-6127
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Country | US
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Telephone | 956-687-4559
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Fax | 956-618-1342
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | MR. OMAR PALOMIN
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Credential | P.T.
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Telephone | 956-687-4559
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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 | 1139541
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License Number State | TX
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