Provider Demographics
NPI:1275838518
Name:PERFORMANCE SPORTS MEDICINE, INC.
Entity Type:Organization
Organization Name:PERFORMANCE SPORTS MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-342-0400
Mailing Address - Street 1:P.O BOX 863268
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75086
Mailing Address - Country:US
Mailing Address - Phone:214-342-0400
Mailing Address - Fax:214-342-0406
Practice Address - Street 1:13601 PRESTON RD
Practice Address - Street 2:STE. E525
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4911
Practice Address - Country:US
Practice Address - Phone:214-342-0400
Practice Address - Fax:214-342-0406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty