NPIMap

Organization Active NPI

Performance Physical Therapy of Stafford, LLC

  • Physical Therapist
  • Stafford, VA
National Provider Identifier
1083928949
Registry record updated Sep 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305204166 Issued in VA
Legal business name
PERFORMANCE PHYSICAL THERAPY OF STAFFORD, LLC
Practice address
2777 Jefferson Davis Hwy
109
Stafford, VA 22554-8323
Phone
(540) 318-8615
Fax
(540) 318-8619
NPI assigned
Aug 3, 2010
Last updated
Sep 17, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2014

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

Authorized official

Name
Dr. Latasha R Blanton, DPTNPI 1518151091
Title
Owner
Phone
(540) 327-1740

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305204166 VA Primary
Geriatric Physical Therapist 2251G0304X 2305204166 VA
Pediatric Physical Therapist 2251P0200X 2305204166 VA
Sports Physical Therapist 2251S0007X 2305204166 VA
Orthopedic Physical Therapist 2251X0800X 2305204166 VA

Addresses

Primary practice location

2777 Jefferson Davis Hwy
109
Stafford, VA 22554-8323

Mailing address

2777 Jefferson Davis Hwy
Suite 109
Stafford, VA 22554-6219
Phone (540) 318-8615

Other identifiers 1

IdentifierTypeStateIssuer
VAA101671OtherVAMEDICARE PTAN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1280793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410912000000",
    "number": "1083928949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2777 JEFFERSON DAVIS HWY",
            "address_2": "SUITE 109",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225546219",
            "telephone_number": "540-318-8615",
            "fax_number": "540-318-8619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2777 JEFFERSON DAVIS HWY",
            "address_2": "109",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225548323",
            "telephone_number": "540-318-8615",
            "fax_number": "540-318-8619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE PHYSICAL THERAPY OF STAFFORD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-03",
        "last_updated": "2014-09-17",
        "status": "A",
        "authorized_official_last_name": "BLANTON",
        "authorized_official_first_name": "LATASHA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "540-327-1740",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305204166",
            "primary": true
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "VA",
            "license": "2305204166",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "VA",
            "license": "2305204166",
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "VA",
            "license": "2305204166",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "VA",
            "license": "2305204166",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "VAA101671",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stafford, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2014; 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.