Provider Demographics
NPI:1669481222
Name:PERFORMANCE GROUP ALBERTVILLE
Entity Type:Organization
Organization Name:PERFORMANCE GROUP ALBERTVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-744-3350
Mailing Address - Street 1:P.O. BOX 14149
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70898-4149
Mailing Address - Country:US
Mailing Address - Phone:225-924-9827
Mailing Address - Fax:225-924-9829
Practice Address - Street 1:4198 U.S. HWY. 431
Practice Address - Street 2:STE D
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35951-0238
Practice Address - Country:US
Practice Address - Phone:256-894-3870
Practice Address - Fax:256-894-3872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2011-08-29
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
K769Medicare PIN