The Performance Center, PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2218 Issued in OK

Legal business name

THE PERFORMANCE CENTER, PLLC

Practice address

511 N Monte Vista St
Ada, OK 74820-4611

Phone

(580) 436-3633

Fax

(580) 436-2977

NPI assigned

Mar 14, 2007

Organization subpart

No

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

Authorized official

Name

Dan Charboneau

Title

Physcial Therapist

Phone

(580) 436-3633

Specialties & licenses 2

Addresses

Other names 1

• The Performance Center of Ada Other name

Locations

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230595200000",
    "number": "1336273317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 N MONTE VISTA ST",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748204611",
            "telephone_number": "580-436-3633",
            "fax_number": "580-436-2977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 N MONTE VISTA ST",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748204611",
            "telephone_number": "580-436-3633",
            "fax_number": "580-436-2977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PERFORMANCE CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2008-12-30",
        "status": "A",
        "authorized_official_last_name": "CHARBONEAU",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "PHYSCIAL THERAPIST",
        "authorized_official_telephone_number": "580-436-3633"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "2218",
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "OK",
            "license": "2218",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Performance Center of Ada",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Physical Therapist in Ada, OK
• Providers in Ada, OK by specialty
• Physical Therapist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2008; 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.