Provider Demographics
NPI:1437264520
Name:PERFORMANCE REHAB INSTITUTE & SPORTS MEDICINE, INC.
Entity Type:Organization
Organization Name:PERFORMANCE REHAB INSTITUTE & SPORTS MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MINEAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:727-781-1223
Mailing Address - Street 1:3450 E LAKE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-2411
Mailing Address - Country:US
Mailing Address - Phone:727-781-1223
Mailing Address - Fax:727-772-1161
Practice Address - Street 1:3450 E LAKE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-2411
Practice Address - Country:US
Practice Address - Phone:727-781-1223
Practice Address - Fax:727-772-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy