Provider Demographics
NPI:1356103162
Name:ROADRUNNER PERFORMANCE & THERAPY
Entity type:Organization
Organization Name:ROADRUNNER PERFORMANCE & THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TROTTER LIND
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:406-880-4171
Mailing Address - Street 1:27 CRESTA VILLA CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-3187
Mailing Address - Country:US
Mailing Address - Phone:406-880-4171
Mailing Address - Fax:
Practice Address - Street 1:27 CRESTA VILLA CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-3187
Practice Address - Country:US
Practice Address - Phone:406-880-4171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy