Provider Demographics
NPI:1831122837
Name:PERFORMANCE THERAPIES, PC
Entity Type:Organization
Organization Name:PERFORMANCE THERAPIES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-665-2630
Mailing Address - Street 1:3290 RIDGEWAY DR
Mailing Address - Street 2:STE 3
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2023
Mailing Address - Country:US
Mailing Address - Phone:319-665-2605
Mailing Address - Fax:319-665-2631
Practice Address - Street 1:3290 RIDGEWAY DR
Practice Address - Street 2:STE 3
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2023
Practice Address - Country:US
Practice Address - Phone:319-665-2605
Practice Address - Fax:319-665-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IADA5328OtherRAILROAD MEDICARE
IA33506OtherWELLMARK BCBS
IA0428987Medicaid
IAF232553OtherMIDLANDS CHOICE
IAF232553OtherMIDLANDS CHOICE