Provider Demographics
NPI:1114223666
Name:PERFORMANCE PODIATRY, INC.
Entity Type:Organization
Organization Name:PERFORMANCE PODIATRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROOF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:513-563-6228
Mailing Address - Street 1:10475 READING ROAD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2500
Mailing Address - Country:US
Mailing Address - Phone:513-563-6228
Mailing Address - Fax:513-577-7261
Practice Address - Street 1:2859 BOUDINOT AVENUE
Practice Address - Street 2:SUITE 107
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-0000
Practice Address - Country:US
Practice Address - Phone:513-563-6228
Practice Address - Fax:513-577-7261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003134213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3075872Medicaid
OH9390561Medicare PIN
OH3075872Medicaid