Provider Demographics
NPI:1396708186
Name:PERFORMANCE REHABILITATION SERVICES, LLC
Entity type:Organization
Organization Name:PERFORMANCE REHABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:SHINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:504-525-2225
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70069-0309
Mailing Address - Country:US
Mailing Address - Phone:504-525-2225
Mailing Address - Fax:504-525-2259
Practice Address - Street 1:301 W AIRLINE HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3823
Practice Address - Country:US
Practice Address - Phone:985-653-9242
Practice Address - Fax:985-653-9324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA225100000X, 2251E1200X, 2251G0304X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Not Answered2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomicsGroup - Single Specialty
Not Answered2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CQ30Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER