Provider Demographics
NPI:1700337466
Name:PERFORMANCE THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:PERFORMANCE THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KADE
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-572-6212
Mailing Address - Street 1:7508 HUNTERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-8866
Mailing Address - Country:US
Mailing Address - Phone:256-572-6212
Mailing Address - Fax:
Practice Address - Street 1:7508 HUNTERWOOD LN
Practice Address - Street 2:
Practice Address - City:OWENS CROSS ROADS
Practice Address - State:AL
Practice Address - Zip Code:35763-8866
Practice Address - Country:US
Practice Address - Phone:256-572-6212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA6012225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty