Provider Demographics
NPI:1710913108
Name:PERFORMANCE PHYSICAL THERAPY GROUP
Entity Type:Organization
Organization Name:PERFORMANCE PHYSICAL THERAPY GROUP
Other - Org Name:PERFORMANCE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEETEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-443-4441
Mailing Address - Street 1:3219 S 70TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5051
Mailing Address - Country:US
Mailing Address - Phone:479-443-4441
Mailing Address - Fax:
Practice Address - Street 1:3219 S 70TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5051
Practice Address - Country:US
Practice Address - Phone:479-443-4441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy