Provider Demographics
NPI:1659581130
Name:PERFORMANCE PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:PERFORMANCE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:RAPPOSELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PT OCS
Authorized Official - Phone:302-234-2288
Mailing Address - Street 1:720 YORKLYN RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8728
Mailing Address - Country:US
Mailing Address - Phone:302-234-2288
Mailing Address - Fax:302-234-2869
Practice Address - Street 1:720 YORKLYN RD
Practice Address - Street 2:SUITE 150
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8728
Practice Address - Country:US
Practice Address - Phone:302-234-2288
Practice Address - Fax:302-234-2869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10000538261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEDG4298OtherMEDICARE RAILROAD
DEG02691Medicare PIN