Provider Demographics
NPI:1730252693
Name:NOSTREBOR PERFORMANCE ASSOCIATES
Entity type:Organization
Organization Name:NOSTREBOR PERFORMANCE ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:803-279-1699
Mailing Address - Street 1:507 W MARTINTOWN RD STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3108
Mailing Address - Country:US
Mailing Address - Phone:803-279-1699
Mailing Address - Fax:803-279-1698
Practice Address - Street 1:507 W MARTINTOWN RD STE B
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3108
Practice Address - Country:US
Practice Address - Phone:803-279-1699
Practice Address - Fax:803-279-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty