Provider Demographics
NPI:1275123283
Name:PERFORMANCE PHYSIO, PLLC
Entity Type:Organization
Organization Name:PERFORMANCE PHYSIO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT, FAAOMPT
Authorized Official - Phone:480-410-8780
Mailing Address - Street 1:2315 E 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85119-3690
Mailing Address - Country:US
Mailing Address - Phone:480-410-8780
Mailing Address - Fax:
Practice Address - Street 1:MOBILE SERVICE/HOUSE CALLS
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296
Practice Address - Country:US
Practice Address - Phone:480-410-8780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-23
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty