| Organization Name: | PERFORMANCE BACK |
| NPI Number: | 1629241856 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAUL MICHAEL LEAHY (OWNER) |
| Mailing Address: | 175 S Union Blvd Suite 230 Colorado Springs |
| State: | CO US |
| Postal Code: | 809103113 |
| Phone Number: | 7194737478 |
| Fax Number: | 7194737479 |
| NPI Enumeration Date: | 04/09/2008 |
| NPI Last Update Date: | 04/09/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225400000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Rehabilitation Practitioner |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. |