| Organization Name: | ICON PERFORMANCE |
| NPI Number: | 1154662278 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TERRI CONNELL (CREDENTIALING MANAGER) |
| Mailing Address: | 3156 Sunview Dr Vestavia |
| State: | AL US |
| Postal Code: | 352435433 |
| Phone Number: | 2059392914 |
| Fax Number: | |
| NPI Enumeration Date: | 03/14/2013 |
| NPI Last Update Date: | 03/14/2013 |
| 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: | |