Provider Demographics
NPI:1588673131
Name:PERFORMANCE GROUP CULLMAN, LLC
Entity Type:Organization
Organization Name:PERFORMANCE GROUP CULLMAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORA
Authorized Official - Middle Name:H
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-871-7294
Mailing Address - Street 1:4 OFFICE PARK CIR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2511
Mailing Address - Country:US
Mailing Address - Phone:205-871-7242
Mailing Address - Fax:205-871-7240
Practice Address - Street 1:1701 MAIN AVE SW
Practice Address - Street 2:SUITE G
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5299
Practice Address - Country:US
Practice Address - Phone:256-775-0400
Practice Address - Fax:256-775-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK753Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER