Provider Demographics
NPI:1750355996
Name:PERFORMANCE THERAPEUTICS PLLC
Entity type:Organization
Organization Name:PERFORMANCE THERAPEUTICS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PALOMIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:956-381-1600
Mailing Address - Street 1:2101 N 23RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6127
Mailing Address - Country:US
Mailing Address - Phone:956-687-4559
Mailing Address - Fax:956-618-1342
Practice Address - Street 1:2502 W FREDDY GONZALEZ DR STE B
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7388
Practice Address - Country:US
Practice Address - Phone:956-687-4560
Practice Address - Fax:956-618-1342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1139541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161271501Medicaid
TX0030KMOtherBCBS
TX610717400OtherWORKERS COMPENSATION
TX0030KMOtherBCBS
P95120Medicare UPIN