Provider Demographics
NPI:1508166604
Name:PERFORMANCE PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:PERFORMANCE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:CROOK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:859-887-0599
Mailing Address - Street 1:2061 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9704
Mailing Address - Country:US
Mailing Address - Phone:859-887-0599
Mailing Address - Fax:859-887-0979
Practice Address - Street 1:2061 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-9704
Practice Address - Country:US
Practice Address - Phone:859-887-0599
Practice Address - Fax:859-887-0979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT001503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700835410OtherNPI INDIVIDUAL NUMBER