NPIMap

Organization Active NPI

Performancepro Sports Medicine and Rehabilitation

  • Durable Medical Equipment & Medical Supplies
  • Tyler, TX
National Provider Identifier
1063663227
Registry record updated Mar 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PERFORMANCEPRO SPORTS MEDICINE AND REHABILITATION
Practice address
4135 S Broadway Ave
Tyler, TX 75701-8720
Phone
(903) 581-8662
Fax
(903) 581-7808
NPI assigned
Oct 7, 2008
Last updated
Mar 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Janna King, JD
Title
VP, Authorized Official
Phone
(713) 297-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary

Addresses

Primary practice location

4135 S Broadway Ave
Tyler, TX 75701-8720

Mailing address

4135 S Broadway Ave
Tyler, TX 75701-8720
Phone (903) 581-8662

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583193600000",
    "number": "1063663227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4135 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018720",
            "telephone_number": "903-581-8662",
            "fax_number": "903-581-7808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4135 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018720",
            "telephone_number": "903-581-8662",
            "fax_number": "903-581-7808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCEPRO SPORTS MEDICINE AND REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-07",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "JANNA",
        "authorized_official_title_or_position": "VP, AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "713-297-7000",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.