Provider Demographics
NPI:1548630189
Name:PERFORMANCE PHYSICAL THERAPY OF DARIEN LLC
Entity type:Organization
Organization Name:PERFORMANCE PHYSICAL THERAPY OF DARIEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:201-264-6983
Mailing Address - Street 1:800 POST RD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4622
Mailing Address - Country:US
Mailing Address - Phone:203-422-0679
Mailing Address - Fax:
Practice Address - Street 1:800 POST RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4622
Practice Address - Country:US
Practice Address - Phone:203-422-0679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERFORMANCE HEALTHCARE MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-25
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14.0074400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty