Provider Demographics
NPI:1952541393
Name:PERFORMANCE ORTHOTICS, P.C.
Entity Type:Organization
Organization Name:PERFORMANCE ORTHOTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:GAINER
Authorized Official - Suffix:
Authorized Official - Credentials:CPED, BOCF
Authorized Official - Phone:281-973-9913
Mailing Address - Street 1:22704 LOOP 494 STE E
Mailing Address - Street 2:SUITE E
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2858
Mailing Address - Country:US
Mailing Address - Phone:281-973-9913
Mailing Address - Fax:281-973-9945
Practice Address - Street 1:22704 LOOP 494 STE E
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2858
Practice Address - Country:US
Practice Address - Phone:281-973-9913
Practice Address - Fax:281-973-9945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6355220001Medicare NSC