Provider Demographics
NPI:1043436561
Name:PERFORMANCE REHAB
Entity Type:Organization
Organization Name:PERFORMANCE REHAB
Other - Org Name:PERFORMANCE ORTHOPEDICS EAST LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEVORAH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-765-3200
Mailing Address - Street 1:721 SE 17TH ST
Mailing Address - Street 2:STE 104
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2983
Mailing Address - Country:US
Mailing Address - Phone:954-765-3200
Mailing Address - Fax:954-765-3206
Practice Address - Street 1:2303 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6711
Practice Address - Country:US
Practice Address - Phone:954-765-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM18935225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8746Medicare UPIN