Provider Demographics
NPI:1396565602
Name:PERFORMANCE HYPERBARIC LLC
Entity type:Organization
Organization Name:PERFORMANCE HYPERBARIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-427-5655
Mailing Address - Street 1:1472 SE SUNSHINE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-6009
Mailing Address - Country:US
Mailing Address - Phone:347-427-5655
Mailing Address - Fax:
Practice Address - Street 1:1929 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9303
Practice Address - Country:US
Practice Address - Phone:347-427-5655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty