Provider Demographics
NPI:1841057114
Name:PERFORMANCE EDGE THERAPY
Entity type:Organization
Organization Name:PERFORMANCE EDGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAYME
Authorized Official - Middle Name:KATHARINE
Authorized Official - Last Name:HOGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR/L
Authorized Official - Phone:509-630-3009
Mailing Address - Street 1:597 MEEKS RD
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-9714
Mailing Address - Country:US
Mailing Address - Phone:509-888-3803
Mailing Address - Fax:509-888-3904
Practice Address - Street 1:404 S. COLUMBIA SUITE B
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801
Practice Address - Country:US
Practice Address - Phone:509-630-3009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty