NPIMap

Organization Active NPI

Performance Physical Therapy, LLC

  • Physical Therapist
  • Port Orange, FL
National Provider Identifier
1700835808
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT22239 Issued in FL
Legal business name
PERFORMANCE PHYSICAL THERAPY, LLC
Practice address
5100 S Clyde Morris Blvd
Suite 200
Port Orange, FL 32127-8976
Phone
(386) 304-8112
Fax
(386) 304-8014
NPI assigned
May 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Vicki Valentine
Title
Vice President of Business Affairs
Phone
(219) 922-9508

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT22239 FL Primary

Addresses

Primary practice location

5100 S Clyde Morris Blvd
Suite 200
Port Orange, FL 32127-8976

Mailing address

9711 Valparaiso Dr
Suite 2
Munster, IN 46321-2866
Phone (219) 922-9508

National Provider Directory

National Provider Directory

Locations

Dept 6000
Carol Stream, IL 60122

9711 Valparaiso Dr
Ste 2
Munster, IN 46321

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700835808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9711 VALPARAISO DR",
            "address_2": "SUITE 2",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212866",
            "telephone_number": "219-922-9508",
            "fax_number": "219-924-4978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 S CLYDE MORRIS BLVD",
            "address_2": "SUITE 200",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321278976",
            "telephone_number": "386-304-8112",
            "fax_number": "386-304-8014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VALENTINE",
        "authorized_official_first_name": "VICKI",
        "authorized_official_title_or_position": "VICE PRESIDENT OF BUSINESS AFFAIRS",
        "authorized_official_telephone_number": "219-922-9508",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT22239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.