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NPI Code Detail

MEDICARE: PERFORMAX PHYSICAL THERAPY WELLNESS, P.C.

MEDICARE: PERFORMAX PHYSICAL THERAPY WELLNESS, P.C.
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
1225100000XPhysical TherapistNY

General Provider Information

NPI Number : 1710227715
Entity Type Code : Organization
Provider Name (Legal Business Name) : PERFORMAX PHYSICAL THERAPY WELLNESS, P.C.
Provider Business Mailing Address
First Line : 150 BAY SHORE RD
Second Line :
City : NORTH BABYLON
State : NY
Zip : 11703-1711
Country : US
Telephone Number : 631-586-6616
Fax Number : 631-586-6617
Provider Business Practice Location Address
First Line : 150 BAY SHORE RD
Second Line :
City : NORTH BABYLON
State : NY
Zip : 11703-1711
Country : US
Telephone Number : 631-586-6616
Fax Number : 631-586-6617
Authorized Official
Title or Position : OWNER
Name : JESSICA TORRES
Credential : PHYSICAL THERAPIST
Telephone Number : 631-827-2500
Provider Enumeration Date : 02/27/2013
Last Update Date : 01/21/2019

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1023672912 — ANTHONY SIMON
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1184331894 — VINCENT PAUL BONURA DPT
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Directions to “PERFORMAX PHYSICAL THERAPY WELLNESS, P.C. ” Practice Location

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