Provider Demographics
NPI:1255538005
Name:PERFORMANCE SPINE & REHABILITATION INC
Entity type:Organization
Organization Name:PERFORMANCE SPINE & REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LEPITO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-472-9625
Mailing Address - Street 1:10 FILA WAY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9452
Mailing Address - Country:US
Mailing Address - Phone:410-472-9625
Mailing Address - Fax:410-472-9627
Practice Address - Street 1:10 FILA WAY
Practice Address - Street 2:SUITE 208
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152-9452
Practice Address - Country:US
Practice Address - Phone:410-472-9625
Practice Address - Fax:410-472-9627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty