MEDICARE: PERFORMANCE GROUP BIRMINGHAM, LLC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1588673206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE GROUP BIRMINGHAM, LLC

Provider Business Mailing Address
First Line	:	4 OFFICE PARK CIR
Second Line	:	SUITE 103
City	:	BIRMINGHAM
State	:	AL
Zip	:	35223-2511
Country	:	US
Telephone Number	:	205-871-7242
Fax Number	:	205-871-7240

Provider Business Practice Location Address
First Line	:	2017 CANYON RD
Second Line	:	SUITE 21
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-1900
Country	:	US
Telephone Number	:	205-822-8320
Fax Number	:	205-822-8323

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	MS. LORA H HESTER
Credential	:
Telephone Number	:	205-871-7294

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	08/22/2020

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