| Organization Name: | PERFORMANCE PT LLC |
| NPI Number: | 1003196213 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRAD SAMPLES (OWNER) |
| Mailing Address: | 15 Corporate Dr Ste 6 Wayne |
| State: | NJ US |
| Postal Code: | 074703120 |
| Phone Number: | 9733684907 |
| Fax Number: | 9733684909 |
| NPI Enumeration Date: | 08/18/2011 |
| NPI Last Update Date: | 08/18/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |