Provider Demographics
NPI:1790935567
Name:EXTREME PERFORMANCE AND REHABILITATION,LLC
Entity Type:Organization
Organization Name:EXTREME PERFORMANCE AND REHABILITATION,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ESQUEDA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:928-446-3473
Mailing Address - Street 1:2205 W 23RD ST STE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8869
Mailing Address - Country:US
Mailing Address - Phone:928-446-3473
Mailing Address - Fax:
Practice Address - Street 1:2205 W 23RD ST STE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8869
Practice Address - Country:US
Practice Address - Phone:928-446-3473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3395261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation