Provider Demographics
NPI:1811347818
Name:PERFORMANCE THERAPEUTICS - SAN ANTONIO PLLC
Entity type:Organization
Organization Name:PERFORMANCE THERAPEUTICS - SAN ANTONIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PALOMIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:956-687-4560
Mailing Address - Street 1:2101 N 23RD ST
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:956-687-4560
Mailing Address - Fax:
Practice Address - Street 1:7220 LOUIS PASTEUR DR STE 144
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4534
Practice Address - Country:US
Practice Address - Phone:956-687-4560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX680380000OtherFACILITY LICENSE