Provider Demographics
NPI:1538209762
Name:QUALITY PERFORMANCE REHABILITATION INC.
Entity type:Organization
Organization Name:QUALITY PERFORMANCE REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, PT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:772-873-8980
Mailing Address - Street 1:441 NW PRIMA VISTA BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983
Mailing Address - Country:US
Mailing Address - Phone:772-873-8980
Mailing Address - Fax:772-873-8981
Practice Address - Street 1:441 NW PRIMA VISTA BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983
Practice Address - Country:US
Practice Address - Phone:772-873-8980
Practice Address - Fax:772-873-8981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY917ZOtherBCBS
FLY917ZOtherBCBS
FLY7973AMedicare UPIN
FLK2704Medicare ID - Type UnspecifiedGROUP