Provider Demographics
NPI:1902971898
Name:ABSOLUTE PERFORMANCE THERAPY, PC
Entity Type:Organization
Organization Name:ABSOLUTE PERFORMANCE THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OF PC
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:SUBBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:515-987-6267
Mailing Address - Street 1:225 EAST HICKMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-9616
Mailing Address - Country:US
Mailing Address - Phone:515-987-6267
Mailing Address - Fax:
Practice Address - Street 1:225 EAST HICKMAN ROAD
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-9616
Practice Address - Country:US
Practice Address - Phone:515-987-6267
Practice Address - Fax:515-987-6269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02888208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA(0)449579Medicaid
IAI10958Medicare ID - Type Unspecified