Provider Demographics
NPI:1578336822
Name:PERFORMANCE 21 PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PERFORMANCE 21 PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:KNUCKLES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:314-330-3002
Mailing Address - Street 1:1311 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-6500
Mailing Address - Country:US
Mailing Address - Phone:314-330-3002
Mailing Address - Fax:833-672-3141
Practice Address - Street 1:1311 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-6500
Practice Address - Country:US
Practice Address - Phone:314-330-3002
Practice Address - Fax:833-672-3141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy