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General NPI Number Information
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NPI Number | 1790722668
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Entity Type | Organization
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Legal Business Name | PERFORMANCE PHYSICAL THERAPY & REHAB OF ORMOND BEACH, LLC
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 53 N KINGS RD
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City | ORMOND BEACH
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State | FL
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Zip | 32174-9519
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Country | US
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Telephone | 386-615-6464
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Fax |
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Provider Business Mailing Address
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Address Line | 53 N KINGS RD
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City | ORMOND BEACH
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State | FL
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Zip | 32174-9519
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Country | US
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Telephone | 386-615-6464
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | TIMOTHY D'AVY
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Credential | PT
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Telephone | 386-615-6464
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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 |
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License Number State |
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