Provider Demographics
NPI:1780186742
Name:PERFORMANCE PHYSICAL THERAPY OF EL PASO PLLC
Entity Type:Organization
Organization Name:PERFORMANCE PHYSICAL THERAPY OF EL PASO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-393-4505
Mailing Address - Street 1:1930 THOREAU DR N STE 165
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4179
Mailing Address - Country:US
Mailing Address - Phone:847-393-4505
Mailing Address - Fax:
Practice Address - Street 1:820 E REDD RD STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7221
Practice Address - Country:US
Practice Address - Phone:915-581-0712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty