Provider Demographics
NPI:1316015548
Name:PERFORMANCE ORTHOTICS, L.L.C.
Entity Type:Organization
Organization Name:PERFORMANCE ORTHOTICS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:NEIGHBORS
Authorized Official - Suffix:
Authorized Official - Credentials:CO, BOCO
Authorized Official - Phone:573-268-6750
Mailing Address - Street 1:2409 OAKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-2280
Mailing Address - Country:US
Mailing Address - Phone:573-268-6750
Mailing Address - Fax:
Practice Address - Street 1:2409 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-2280
Practice Address - Country:US
Practice Address - Phone:573-268-6750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier