Provider Demographics
NPI:1710102140
Name:PERFORMANCE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:PERFORMANCE PHYSICAL THERAPY INC
Other - Org Name:PERFORMANCE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:PLACELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:301-938-7915
Mailing Address - Street 1:13704 HARVEST GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-6250
Mailing Address - Country:US
Mailing Address - Phone:301-938-7915
Mailing Address - Fax:410-431-7042
Practice Address - Street 1:877 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4700
Practice Address - Country:US
Practice Address - Phone:410-431-7040
Practice Address - Fax:410-431-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy