Provider Demographics
NPI:1821720863
Name:G5 PERFORMANCE PHYSIO INC
Entity Type:Organization
Organization Name:G5 PERFORMANCE PHYSIO INC
Other - Org Name:G5 PERFORMANCE SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT SMS
Authorized Official - Phone:646-694-9222
Mailing Address - Street 1:133 E 58TH ST
Mailing Address - Street 2:902
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1285
Mailing Address - Country:US
Mailing Address - Phone:646-694-9222
Mailing Address - Fax:
Practice Address - Street 1:133 E 58TH ST
Practice Address - Street 2:902
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1285
Practice Address - Country:US
Practice Address - Phone:646-694-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty