NPIMap

Organization Active NPI

Performance Physical Therapy & Sports Conditioning LLC

  • Physical Therapist
  • Wayne, NJ
National Provider Identifier
1376763722
Registry record updated Feb 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01180900 Issued in NJ
Legal business name
PERFORMANCE PHYSICAL THERAPY & SPORTS CONDITIONING LLC
Practice address
2025 Hamburg Tpke Ste E
Wayne, NJ 07470-6250
Phone
(973) 835-2827
Fax
(973) 835-1856
NPI assigned
Apr 26, 2007
Last updated
Feb 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2024

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

Authorized official

Name
Brad Samples, DPT, ATCNPI 1679605752
Title
Partner, Physical Therapist
Phone
(201) 286-0585

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 40QA01180900 NJ Primary

Addresses

Primary practice location

2025 Hamburg Tpke Ste E
Wayne, NJ 07470-6250

Mailing address

2025 Hamburg Tpke Ste E
Wayne, NJ 07470-6250
Phone (973) 835-2827

Other practice location 1

15 Corporate Dr
Unit 6
Wayne, NJ 07470-3112
Phone (973) 368-4907 ext. 12

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111018000048 NJ Part B Supplier - Clinic/Group Practice 6103098165 Receives reassigned benefits from 6 practitioners
Practice locations: Wayne, NJ

National Provider Directory

National Provider Directory

Locations

2025 Hamburg Tpke
Ste E
Wayne, NJ 07470
Phone (201) 835-2827

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706832000000",
    "number": "1376763722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2025 HAMBURG TPKE STE E",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074706250",
            "telephone_number": "973-835-2827",
            "fax_number": "973-835-1856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 HAMBURG TPKE STE E",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074706250",
            "telephone_number": "973-835-2827",
            "fax_number": "973-835-1856"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15 Corporate Dr",
            "address_2": "Unit 6",
            "address_purpose": "LOCATION",
            "city": "Wayne",
            "state": "NJ",
            "postal_code": "074703112",
            "country_code": "US",
            "telephone_number": "973-368-4907 x12",
            "fax_number": "973-368-4909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PERFORMANCE PHYSICAL THERAPY & SPORTS CONDITIONING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A",
        "authorized_official_last_name": "SAMPLES",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "PARTNER, PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "201-286-0585",
        "authorized_official_credential": "DPT, ATC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01180900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2024; 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.