Provider Demographics
NPI:1518594704
Name:PERFORMANCE PROSTHETICS & ORTHOTICS, PL
Entity Type:Organization
Organization Name:PERFORMANCE PROSTHETICS & ORTHOTICS, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-607-6126
Mailing Address - Street 1:3010 N 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-4067
Mailing Address - Country:US
Mailing Address - Phone:850-607-6126
Mailing Address - Fax:850-607-6674
Practice Address - Street 1:753 ASHLEY DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-9231
Practice Address - Country:US
Practice Address - Phone:850-331-3664
Practice Address - Fax:850-607-6674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier