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Organization
PERFORMANCEPRO SPORTS MEDICINE AND REHABILITATION
Active
Organization
PERFORMANCEPRO SPORTS MEDICINE AND REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANNA KING JD (VP, AUTHORIZED OFFICIAL)
(713) 297-7000
Entity
Organization
Contact information
Practice address
4135 S BROADWAY AVE, TYLER, TX 75701-8720
(903) 581-8662
(903) 581-7808
Mailing address
4135 S BROADWAY AVE, TYLER, TX 75701-8720
(903) 581-8662
(903) 581-7808
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NULL
Other
Enumeration date
10/07/2008
Last updated
03/03/2020
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