Provider Demographics
NPI:1922355023
Name:PER4MANCE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:PER4MANCE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:918-923-4700
Mailing Address - Street 1:224 S BRADY ST STE 109
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-5085
Mailing Address - Country:US
Mailing Address - Phone:918-923-4700
Mailing Address - Fax:918-923-4701
Practice Address - Street 1:224 S BRADY ST STE 109
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5085
Practice Address - Country:US
Practice Address - Phone:918-923-4700
Practice Address - Fax:918-923-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy