Provider Demographics
NPI:1437346178
Name:PERFORMANCE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:PERFORMANCE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-593-8786
Mailing Address - Street 1:10 CANALVIEW MALL
Mailing Address - Street 2:SUITE C
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1769
Mailing Address - Country:US
Mailing Address - Phone:315-593-8786
Mailing Address - Fax:315-598-5538
Practice Address - Street 1:10 CANALVIEW MALL
Practice Address - Street 2:SUITE C
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1769
Practice Address - Country:US
Practice Address - Phone:315-593-8786
Practice Address - Fax:315-598-5538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0806Medicare UPIN