Provider Demographics
NPI:1326665597
Name:PHYSIOHEALTH PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PHYSIOHEALTH PHYSICAL THERAPY, INC.
Other - Org Name:PERFORMANCE EVOLUTION, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:781-859-4189
Mailing Address - Street 1:560 KELLEY BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-4185
Mailing Address - Country:US
Mailing Address - Phone:781-859-4189
Mailing Address - Fax:781-757-3564
Practice Address - Street 1:560 KELLEY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-4185
Practice Address - Country:US
Practice Address - Phone:781-859-4189
Practice Address - Fax:781-757-3564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty