Provider Demographics
NPI:1508933870
Name:PERFORMANCE ONE
Entity Type:Organization
Organization Name:PERFORMANCE ONE
Other - Org Name:PERFORMANCE ONE SPORTS MARKETING AND MANAGEMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF SPORTS MEDICINE
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHURST
Authorized Official - Suffix:
Authorized Official - Credentials:ATC, LAT
Authorized Official - Phone:407-290-2471
Mailing Address - Street 1:1768 PARK CENTER DR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6200
Mailing Address - Country:US
Mailing Address - Phone:407-290-2471
Mailing Address - Fax:
Practice Address - Street 1:1768 PARK CENTER DR
Practice Address - Street 2:SUITE 360
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6200
Practice Address - Country:US
Practice Address - Phone:407-290-2471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 1542225400000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty