Provider Demographics
NPI:1346380813
Name:QUALITY PERFORMANCE REHABILITATION INC.
Entity Type:Organization
Organization Name:QUALITY PERFORMANCE REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST,VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:772-873-8980
Mailing Address - Street 1:1143 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-5131
Mailing Address - Country:US
Mailing Address - Phone:772-460-2520
Mailing Address - Fax:772-460-2521
Practice Address - Street 1:1143 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-5131
Practice Address - Country:US
Practice Address - Phone:772-460-2520
Practice Address - Fax:772-460-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY917ZOtherBCBS
FLY7973AMedicare ID - Type UnspecifiedINDIVIDUAL
FLY0235ZMedicare ID - Type UnspecifiedINDIVIDUAL
FLK2704Medicare ID - Type UnspecifiedMEDICARE GROUP
FLY056EZMedicare ID - Type UnspecifiedINDIVIDUAL