MEDICARE: PERFORMANCE GROUP ALBERTVILLE

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	:	1669481222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE GROUP ALBERTVILLE

Provider Business Mailing Address
First Line	:	P.O. BOX 14149
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70898-4149
Country	:	US
Telephone Number	:	225-924-9827
Fax Number	:	225-924-9829

Provider Business Practice Location Address
First Line	:	4198 U.S. HWY. 431
Second Line	:	STE D
City	:	ALBERTVILLE
State	:	AL
Zip	:	35951-0238
Country	:	US
Telephone Number	:	256-894-3870
Fax Number	:	256-894-3872

Authorized Official
Title or Position	:	BILLING COORDINATOR
Name	:	DANIEL ANDREW DAVIS
Credential	:
Telephone Number	:	256-744-3350

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	08/29/2011

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Directions to “PERFORMANCE GROUP ALBERTVILLE ” Practice Location

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