Provider Demographics
NPI:1104506203
Name:THE PLATFORM PERFORMANCE AND SPORTS REHAB, PLLC
Entity type:Organization
Organization Name:THE PLATFORM PERFORMANCE AND SPORTS REHAB, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT / CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-717-9361
Mailing Address - Street 1:15102 N 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8996 W UNION HILLS DR STE 107
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3010
Practice Address - Country:US
Practice Address - Phone:602-717-9361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty