Provider Demographics
NPI:1114266525
Name:PERFORMANCE THERAPEUTICS - EAGLE PASS, PLLC
Entity Type:Organization
Organization Name:PERFORMANCE THERAPEUTICS - EAGLE PASS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EDWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CANALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-687-4559
Mailing Address - Street 1:500 LINDBERG AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2924
Mailing Address - Country:US
Mailing Address - Phone:956-687-4559
Mailing Address - Fax:956-687-4554
Practice Address - Street 1:2483 2ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4390
Practice Address - Country:US
Practice Address - Phone:830-776-5181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671310001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty