Provider Demographics
NPI:1083725055
Name:PERFORMANCE PHYSICAL THERAPY & FITNESS, INC.
Entity Type:Organization
Organization Name:PERFORMANCE PHYSICAL THERAPY & FITNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCIANO
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEGASPI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:610-341-9100
Mailing Address - Street 1:320 KING OF PRUSSIA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4440
Mailing Address - Country:US
Mailing Address - Phone:610-341-9100
Mailing Address - Fax:610-341-9993
Practice Address - Street 1:320 KING OF PRUSSIA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-4440
Practice Address - Country:US
Practice Address - Phone:610-341-9100
Practice Address - Fax:610-341-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA080491Medicare ID - Type Unspecified