Provider Demographics
NPI:1437659620
Name:PERFORM PHYSIO
Entity Type:Organization
Organization Name:PERFORM PHYSIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GREENAWALT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, MTC
Authorized Official - Phone:724-831-8337
Mailing Address - Street 1:105 FAIRMONT DR
Mailing Address - Street 2:
Mailing Address - City:ZELIENOPLE
Mailing Address - State:PA
Mailing Address - Zip Code:16063-1701
Mailing Address - Country:US
Mailing Address - Phone:724-831-8337
Mailing Address - Fax:
Practice Address - Street 1:129 MCCARRELL LN
Practice Address - Street 2:
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063-2827
Practice Address - Country:US
Practice Address - Phone:724-831-8337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation