Provider Demographics
NPI:1144766064
Name:PERFORMANCE PLUS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PERFORMANCE PLUS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, CSCS
Authorized Official - Phone:858-336-0163
Mailing Address - Street 1:1392 E PALOMAR ST STE 503
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1895
Mailing Address - Country:US
Mailing Address - Phone:619-482-3000
Mailing Address - Fax:
Practice Address - Street 1:1392 E PALOMAR ST STE 503
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1895
Practice Address - Country:US
Practice Address - Phone:619-482-3000
Practice Address - Fax:619-482-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty