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General NPI Number Information
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NPI Number | 1750967097
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Entity Type | Organization
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Legal Business Name | PERFORMANCE EDUCATION LLC
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Dates
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Enumeration Date | 03/18/2021
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 14609 6 MILE CYPRESS PKWY
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City | FORT MYERS
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State | FL
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Zip | 33912-4465
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Country | US
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Telephone | 239-202-2910
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Fax |
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Provider Business Mailing Address
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Address Line | 9848 COLONIAL WALK S
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City | ESTERO
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State | FL
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Zip | 33928-6309
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Country | US
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Telephone | 561-699-2560
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIRBY RETZER
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Credential |
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Telephone | 561-699-2560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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