MEDICARE: PERFORMANCE PHYSICAL THERAPY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1447762661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE PHYSICAL THERAPY, PC

Provider Business Mailing Address
First Line	:	825 SAGEBRUSH LN STE 1
Second Line	:
City	:	DEER LODGE
State	:	MT
Zip	:	59722-2320
Country	:	US
Telephone Number	:	406-846-7771
Fax Number	:	406-846-7771

Provider Business Practice Location Address
First Line	:	124 OAK ST
Second Line	:
City	:	ANACONDA
State	:	MT
Zip	:	59711-2335
Country	:	US
Telephone Number	:	406-846-7770
Fax Number	:	406-846-7771

Authorized Official
Title or Position	:	OWNER
Name	:	ERIC SHANE SPEARS
Credential	:	PT
Telephone Number	:	406-543-1546

Provider Enumeration Date	:	10/27/2017
Last Update Date	:	08/16/2019

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