Performance Physio PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

PERFORMANCE PHYSIO PLLC

Doing business as

Performance Health and Wellness
Performance Physio

Practice address

621 Main St Ste a
Lewiston, ID 83501-1871

Phone

(509) 769-7551

Fax

(509) 254-5018

NPI assigned

Sep 21, 2018

Last updated

Jan 28, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kyle Joseph Palmer, PTNPI 1699203455

Title

Owner

Phone

(509) 780-1090

Specialties & licenses 1

Addresses

Other names 2

• Performance Health and Wellness Doing business as
• Performance Physio Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 2

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.

• Kyle Palmer, PT

  • Physical Therapist
  • Lewiston, ID
  • NPI 1699203455
  Medicare reassignment NPD Authorized official
• Tara Kazemfar, PT

  • Physical Therapist
  • Lewiston, ID
  • NPI 1356996391
  Medicare reassignment NPD

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

{
    "created_epoch": "1537488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611792000000",
    "number": "1073097390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 MAIN ST STE A",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835011871",
            "telephone_number": "509-769-7551",
            "fax_number": "509-254-5018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 MAIN ST STE A",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835011871",
            "telephone_number": "509-769-7551",
            "fax_number": "509-254-5018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE PHYSIO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-21",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A",
        "authorized_official_last_name": "PALMER",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-780-1090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Performance Health and Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Performance Physio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peak Performance Physical Therapy
• Lynn-Marie Morgan Peashka, PMHNP-BC
• Pebble Creek Dental & Implants PLLC
• Joshua Robert Peregoy, PTA
• William Joseph Perez, D.M.D.
• Perio Docs - Lewiston PLLC
• David A Petersen, MD
• Alan Clifton Peterson, M.D.
• Lisa Peterson, PHARMD
• Mark W Peterson, M.D.

• Physical Therapy Clinic/Center in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Physical Therapy Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.