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General NPI Number Information
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NPI Number | 1639261399
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Entity Type | Organization
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Legal Business Name | PERFORMANCE REHABILITATION, PC
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 590 UNION BLVD
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City | TOTOWA
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State | NJ
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Zip | 07512-2443
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Country | US
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Telephone | 973-237-1975
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Fax | 973-237-1977
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Provider Business Mailing Address
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Address Line | 590 UNION BLVD
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City | TOTOWA
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State | NJ
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Zip | 07512-2443
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Country | US
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Telephone | 973-237-1975
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Fax | 973-237-1977
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Authorized Official
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Title or Position | OWNER
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Name | DAMON DAURA
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Credential | PT
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Telephone | 973-237-1975
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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 | 40QA00548200
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License Number State | NJ
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