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General NPI Number Information
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NPI Number | 1962152363
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Entity Type | Organization
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Legal Business Name | PERFORMANCE AND FUNCTION PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/28/2022
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Last Update Date | 03/28/2022
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Provider Practice Location Address
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Address Line | 12339 HOLLYBUSH TER
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-2035
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Country | US
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Telephone | 941-735-1523
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Fax |
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Provider Business Mailing Address
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Address Line | 12339 HOLLYBUSH TER
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-2035
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Country | US
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Telephone | 941-735-1523
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Fax |
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Authorized Official
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Title or Position | OWNER/ PRESIDENT
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Name | RENE S BOURDEAU
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Credential |
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Telephone | 941-735-1523
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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 |
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License Number State |
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