Provider Demographics
NPI:1770892937
Name:PERFORMANCE SPINE & SPORTS PHYSICIANS, P.C.
Entity type:Organization
Organization Name:PERFORMANCE SPINE & SPORTS PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-935-0719
Mailing Address - Street 1:824 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4478
Mailing Address - Country:US
Mailing Address - Phone:610-935-0719
Mailing Address - Fax:
Practice Address - Street 1:824 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4478
Practice Address - Country:US
Practice Address - Phone:610-935-0719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERFORMANCE SPINE & SPORTS PHYSICIANS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-05
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty