Provider Demographics
NPI:1225073877
Name:PERFORMANCE SPINE AND SPORTS PHYSICIANS, PC
Entity Type:Organization
Organization Name:PERFORMANCE SPINE AND SPORTS PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHAPIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-970-4700
Mailing Address - Street 1:1603 E HIGH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-5061
Mailing Address - Country:US
Mailing Address - Phone:610-970-4700
Mailing Address - Fax:610-970-5635
Practice Address - Street 1:1603 E HIGH ST
Practice Address - Street 2:SUITE C
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5061
Practice Address - Country:US
Practice Address - Phone:610-970-4700
Practice Address - Fax:610-970-5635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208100000X, 2081P0004X, 2081P2900X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001720015-0002Medicaid
PA001720015-0004Medicaid
PA001720015-0002Medicaid
PA6563090001Medicare NSC
PA022284Medicare PIN