Provider Demographics
NPI:1013381383
Name:BRAIN PERFORMANCE CENTERS
Entity Type:Organization
Organization Name:BRAIN PERFORMANCE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA/L
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:480-335-3088
Mailing Address - Street 1:6840 E BROWN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-3759
Mailing Address - Country:US
Mailing Address - Phone:480-719-8080
Mailing Address - Fax:
Practice Address - Street 1:6840 E BROWN RD STE 104
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-3759
Practice Address - Country:US
Practice Address - Phone:480-719-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service