MEDICARE: PERFORMANCE THERAPEUTICS - SAN ANTONIO PLLC

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	261QR0400X	Rehabilitation Clinic/Center		TX

General Provider Information

NPI Number	:	1780104679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE THERAPEUTICS - SAN ANTONIO PLLC

Provider Business Mailing Address
First Line	:	2101 N 23RD ST
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78501-6127
Country	:	US
Telephone Number	:	956-687-4555
Fax Number	:	956-687-4554

Provider Business Practice Location Address
First Line	:	7220 LOUIS PASTEUR
Second Line	:	SUITE 144
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4534
Country	:	US
Telephone Number	:	210-290-9335
Fax Number	:	210-290-9623

Authorized Official
Title or Position	:	COO
Name	:	EDWARD R CANALES
Credential	:
Telephone Number	:	956-687-4559

Provider Enumeration Date	:	06/22/2017
Last Update Date	:	08/24/2022

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