Provider Demographics
NPI:1043520752
Name:PERFORMANCE THERAPY, LLC
Entity Type:Organization
Organization Name:PERFORMANCE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER / PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:VAN HULLE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, OMPT
Authorized Official - Phone:586-344-7449
Mailing Address - Street 1:1457 N ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1122
Mailing Address - Country:US
Mailing Address - Phone:248-759-4446
Mailing Address - Fax:248-759-4448
Practice Address - Street 1:1457 N ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-1122
Practice Address - Country:US
Practice Address - Phone:248-759-4446
Practice Address - Fax:248-759-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010847261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy