Provider Demographics
NPI:1447762661
Name:PERFORMANCE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:PERFORMANCE PHYSICAL THERAPY, PC
Other - Org Name:PREMIER PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:406-543-1546
Mailing Address - Street 1:825 SAGEBRUSH LN STE 1
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59722-2320
Mailing Address - Country:US
Mailing Address - Phone:406-846-7771
Mailing Address - Fax:406-846-7771
Practice Address - Street 1:124 OAK ST
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2335
Practice Address - Country:US
Practice Address - Phone:406-846-7770
Practice Address - Fax:406-846-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty