MEDICARE: PERFORMANCE & RECOVERY LAB, 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	261QP2000X	Physical Therapy Clinic/Center	10208	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1407293491	OTHER	AZ	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1699292201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE & RECOVERY LAB, LLC.

Provider Business Mailing Address
First Line	:	3514 N POWER RD STE 133
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-2911
Country	:	US
Telephone Number	:	480-625-6693
Fax Number	:	480-304-3269

Provider Business Practice Location Address
First Line	:	3514 N POWER RD STE 133
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-2911
Country	:	US
Telephone Number	:	480-625-6693
Fax Number	:	480-304-3269

Authorized Official
Title or Position	:	OWNER
Name	:	COURTNEY WARREN
Credential	:	DPT
Telephone Number	:	702-443-1133

Provider Enumeration Date	:	08/24/2017
Last Update Date	:	08/28/2025

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