Provider Demographics
NPI:1538276407
Name:PERFORMAX, LLC
Entity type:Organization
Organization Name:PERFORMAX, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMANATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUPRAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-485-5444
Mailing Address - Street 1:22118 20TH AVE SE
Mailing Address - Street 2:SUITE 139
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021
Mailing Address - Country:US
Mailing Address - Phone:425-485-5444
Mailing Address - Fax:425-485-5588
Practice Address - Street 1:22118 20TH AVE SE
Practice Address - Street 2:SUITE 139
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021
Practice Address - Country:US
Practice Address - Phone:425-485-5444
Practice Address - Fax:425-485-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty