Provider Demographics
NPI:1396503249
Name:PERFORMANCE MODALITIES INC
Entity type:Organization
Organization Name:PERFORMANCE MODALITIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VASILJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-852-5612
Mailing Address - Street 1:19625 62ND AVE S STE A101
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-1106
Mailing Address - Country:US
Mailing Address - Phone:866-687-4463
Mailing Address - Fax:
Practice Address - Street 1:2460 NW STEWART PKWY STE 210
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1516
Practice Address - Country:US
Practice Address - Phone:866-687-4463
Practice Address - Fax:877-414-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies