Provider Demographics
NPI:1073630901
Name:PERFORMANCE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PERFORMANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-302-6415
Mailing Address - Street 1:3795 INDIAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHRUB OAK
Mailing Address - State:NY
Mailing Address - Zip Code:10588-1302
Mailing Address - Country:US
Mailing Address - Phone:914-302-6415
Mailing Address - Fax:914-245-3905
Practice Address - Street 1:3795 INDIAN HILL RD
Practice Address - Street 2:
Practice Address - City:SHRUB OAK
Practice Address - State:NY
Practice Address - Zip Code:10588-1302
Practice Address - Country:US
Practice Address - Phone:914-302-6415
Practice Address - Fax:914-245-3905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEX181Medicare ID - Type UnspecifiedGROUP ID