Provider Demographics
NPI:1700618782
Name:AERIS PERFORMANCE CONCEPTS, LLC
Entity type:Organization
Organization Name:AERIS PERFORMANCE CONCEPTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:DEMBOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DSC, OCS, SCS
Authorized Official - Phone:915-342-7113
Mailing Address - Street 1:305 WIREGRASS LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-3063
Mailing Address - Country:US
Mailing Address - Phone:915-342-7113
Mailing Address - Fax:
Practice Address - Street 1:305 WIREGRASS LN
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-3063
Practice Address - Country:US
Practice Address - Phone:915-342-7113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-17
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty