Organization · NPI-2
Performa Physical Medicine And Wellness
Clinic/Center · Rockwall, TX
NPI number1427778786
StatusActive
Last updated in NPPESAug 29, 2022
Details
- NPI
- 1427778786
- Entity type
- Organization (NPI-2)
- Legal business name
- Performa Physical Medicine And Wellness
- Organization subpart
- No
- Enumeration date
- Aug 29, 2022
- Certification date
- Aug 29, 2022
- Last updated
- Aug 29, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | – | – | Yes |
| 207L00000X | Anesthesiology | – | – | |
| 261QP2000X | Clinic/Center, Physical Therapy | – | – |
Practice location
6435 S Fm 549 Ste 102Rockwall, TX 75032-6221
Phone 303-845-2392
Mailing address
1244 Highland PlErie, CO 80516-7918
Phone 303-845-2382
Authorized official
Peter Laurence Castro
Physician
3038452392
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