Provider Demographics
NPI:1497482145
Name:FENNEC PERFORMAN LLC
Entity Type:Organization
Organization Name:FENNEC PERFORMAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:SEMLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-551-7107
Mailing Address - Street 1:161 STEINWAY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4819
Mailing Address - Country:US
Mailing Address - Phone:718-551-7107
Mailing Address - Fax:
Practice Address - Street 1:161 STEINWAY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4819
Practice Address - Country:US
Practice Address - Phone:718-551-7107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty