MEDICARE: PERFORMANCE PHYSICAL THERAPY GROUP

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	:	1710913108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE PHYSICAL THERAPY GROUP

Provider Business Mailing Address
First Line	:	3219 S 70TH ST
Second Line	:	SUITE 2
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5051
Country	:	US
Telephone Number	:	479-443-4441
Fax Number	:

Provider Business Practice Location Address
First Line	:	3219 S 70TH ST
Second Line	:	SUITE 2
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5051
Country	:	US
Telephone Number	:	479-443-4441
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	STACY SWEETEN
Credential	:
Telephone Number	:	479-443-4441

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	08/22/2020

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