Provider Demographics
NPI:1891726279
Name:PERFORMANCE PHYSICAL THERAPY AND SPORTS CONDITIONING, INC
Entity Type:Organization
Organization Name:PERFORMANCE PHYSICAL THERAPY AND SPORTS CONDITIONING, INC
Other - Org Name:PERFROMANCE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:TONINI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:831-643-1234
Mailing Address - Street 1:19 UPPER RAGSDALE DR
Mailing Address - Street 2:STE 180
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7881
Mailing Address - Country:US
Mailing Address - Phone:831-643-1234
Mailing Address - Fax:831-643-1233
Practice Address - Street 1:19 UPPER RAGSDALE DR
Practice Address - Street 2:STE 180
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7881
Practice Address - Country:US
Practice Address - Phone:831-643-1234
Practice Address - Fax:831-643-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ65099ZOtherBLUE SHIELD OF CA NUMBER
CAZZZ65099ZOtherBLUE SHIELD OF CA NUMBER