Provider Demographics
NPI:1376860585
Name:PRIMO PERFORMANCE AND REHABILITATION, INC.
Entity Type:Organization
Organization Name:PRIMO PERFORMANCE AND REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TRANCHINA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:619-944-5561
Mailing Address - Street 1:300 BOWIE ST
Mailing Address - Street 2:#706
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 BOWIE ST
Practice Address - Street 2:#706
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4661
Practice Address - Country:US
Practice Address - Phone:619-944-5561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1158248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty