Provider Demographics
NPI:1801879853
Name:PERFORMANCE THERAPY GROUP, INC.
Entity type:Organization
Organization Name:PERFORMANCE THERAPY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SWARM
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:330-752-4370
Mailing Address - Street 1:4986 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8637
Mailing Address - Country:US
Mailing Address - Phone:330-752-4370
Mailing Address - Fax:
Practice Address - Street 1:4986 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8637
Practice Address - Country:US
Practice Address - Phone:330-752-4370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPE9355171Medicare ID - Type Unspecified