Provider Demographics
NPI:1639465644
Name:TOTAL PERFORMANCE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:TOTAL PERFORMANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ERICA
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:215-997-9898
Mailing Address - Street 1:1501 LOWER STATE RD
Mailing Address - Street 2:STE 308
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1216
Mailing Address - Country:US
Mailing Address - Phone:215-997-9898
Mailing Address - Fax:215-997-9899
Practice Address - Street 1:1501 LOWER STATE RD
Practice Address - Street 2:SUITE 308
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-1216
Practice Address - Country:US
Practice Address - Phone:215-997-9898
Practice Address - Fax:215-997-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17352261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy