Provider Demographics
NPI:1932899945
Name:PERFORM PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:PERFORM PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:HOLOWACZ
Authorized Official - Last Name:MUNRO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:607-351-3665
Mailing Address - Street 1:8 DELVIEW TER EXT STE 2
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:NY
Mailing Address - Zip Code:13753-1046
Mailing Address - Country:US
Mailing Address - Phone:607-386-1440
Mailing Address - Fax:607-304-5558
Practice Address - Street 1:8 DELVIEW TER EXT STE 2
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:NY
Practice Address - Zip Code:13753-1046
Practice Address - Country:US
Practice Address - Phone:607-386-1440
Practice Address - Fax:607-304-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty