Provider Demographics
NPI:1275014938
Name:DISTRICT PERFORMANCE & PHYSIO
Entity Type:Organization
Organization Name:DISTRICT PERFORMANCE & PHYSIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:607-768-3540
Mailing Address - Street 1:4000 TUNLAW RD NW APT 1021
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4845
Mailing Address - Country:US
Mailing Address - Phone:607-768-3540
Mailing Address - Fax:
Practice Address - Street 1:1722 EYE ST NW BSMT LEVEL
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-3710
Practice Address - Country:US
Practice Address - Phone:202-922-7331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT871842261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy