=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659581130
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERFORMANCE PHYSICAL THERAPY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2007
-----------------------------------------------------
Last Update Date | 11/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 YORKLYN RD SUITE 150
-----------------------------------------------------
City | HOCKESSIN
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19707-8728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-234-2288
-----------------------------------------------------
Fax | 302-234-2869
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 720 YORKLYN RD SUITE 150
-----------------------------------------------------
City | HOCKESSIN
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19707-8728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-234-2288
-----------------------------------------------------
Fax | 302-234-2869
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. STEPHEN V RAPPOSELLI
-----------------------------------------------------
Credential | PT OCS
-----------------------------------------------------
Telephone | 302-234-2288
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | J10000538
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------