Provider Demographics
NPI:1407350507
Name:PERFORMANCE FOOTCARE
Entity Type:Organization
Organization Name:PERFORMANCE FOOTCARE
Other - Org Name:PERFORMANCE ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-945-7790
Mailing Address - Street 1:2024 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1216
Mailing Address - Country:US
Mailing Address - Phone:704-945-7790
Mailing Address - Fax:980-207-4812
Practice Address - Street 1:2024 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1216
Practice Address - Country:US
Practice Address - Phone:704-945-7790
Practice Address - Fax:980-207-4812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty