NPIMap

Organization Active NPI

Performance Rehab LLC

  • Physical Therapist
  • Oelwein, IA
National Provider Identifier
1811052350
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PERFORMANCE REHAB LLC
Practice address
204 E Charles St
Oelwein, IA 50662-1940
Phone
(319) 283-2002
Fax
(319) 283-2015
NPI assigned
Dec 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

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

Authorized official

Name
Todd A. Bradley, DPTNPI 1851469100
Title
PT/Owner
Phone
(319) 283-2002

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

204 E Charles St
Oelwein, IA 50662-1940

Mailing address

204 E. Charles St.
Oelwein, IA 50662-1940
Phone (319) 283-2002

Other practice location 1

1310 12th St
Jesup, IA 50648-1065
Phone (319) 827-3440

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081016000473 IA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4486712619 Receives reassigned benefits from 9 practitioners
Practice locations: Jesup, IA; Oelwein, IA

National Provider Directory

National Provider Directory

Locations

1314 7th St
Ste A
Jesup, IA 50648
Phone (319) 827-3440

1310 12th St
Jesup, IA 50648
Phone (319) 827-3440

204 E Charles St
Oelwein, IA 50662
Phone (319) 239-3777

1005 N Frederick Ave
Ste 4
Oelwein, IA 50662
Phone (319) 283-2002

Practitioners & affiliated clinicians

Practitioners 12

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": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594252800000",
    "number": "1811052350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 E. CHARLES ST.",
            "city": "OELWEIN",
            "state": "IA",
            "postal_code": "506621940",
            "telephone_number": "319-283-2002",
            "fax_number": "319-283-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 E CHARLES ST",
            "city": "OELWEIN",
            "state": "IA",
            "postal_code": "506621940",
            "telephone_number": "319-283-2002",
            "fax_number": "319-283-2015"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1310 12th St",
            "address_purpose": "LOCATION",
            "city": "Jesup",
            "state": "IA",
            "postal_code": "506481065",
            "country_code": "US",
            "telephone_number": "319-827-3440",
            "fax_number": "319-827-3443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PERFORMANCE REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PT/OWNER",
        "authorized_official_telephone_number": "319-283-2002",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oelwein, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; 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.