Provider Demographics
NPI:1780742957
Name:PERFORMANCE THERAPY, INC
Entity type:Organization
Organization Name:PERFORMANCE THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WALKER
Authorized Official - Last Name:GUDGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:507-637-8585
Mailing Address - Street 1:821 EAST BRIDGE ST.
Mailing Address - Street 2:
Mailing Address - City:REDWOOD FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56203-1543
Mailing Address - Country:US
Mailing Address - Phone:507-637-8585
Mailing Address - Fax:507-637-8649
Practice Address - Street 1:821 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283-1801
Practice Address - Country:US
Practice Address - Phone:507-637-8585
Practice Address - Fax:507-637-8649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5776261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center