Provider Demographics
NPI:1003196213
Name:PERFORMANCE PT LLC
Entity Type:Organization
Organization Name:PERFORMANCE PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPLES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:973-368-4907
Mailing Address - Street 1:15 CORPORATE DR STE 6
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3120
Mailing Address - Country:US
Mailing Address - Phone:973-368-4907
Mailing Address - Fax:973-368-4909
Practice Address - Street 1:15 CORPORATE DR STE 6
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3120
Practice Address - Country:US
Practice Address - Phone:973-368-4907
Practice Address - Fax:973-368-4909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty