Provider Demographics
NPI:1124402292
Name:PERFORMANCE PHYSICAL THERAPY, INC. P.S.
Entity Type:Organization
Organization Name:PERFORMANCE PHYSICAL THERAPY, INC. P.S.
Other - Org Name:WHATCOM SPORTS INSTITUTE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WEEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MSPTAT
Authorized Official - Phone:360-303-8420
Mailing Address - Street 1:420 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4637
Mailing Address - Country:US
Mailing Address - Phone:360-714-0870
Mailing Address - Fax:
Practice Address - Street 1:420 OHIO ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4637
Practice Address - Country:US
Practice Address - Phone:360-714-0870
Practice Address - Fax:360-714-0872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
WAPT00006136261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty