# PERFORMANCEPRO SPORTS MEDICINE AND REHABILITATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063663227
- **Authorized official:** JANNA KING JD (VP, AUTHORIZED OFFICIAL)
- **Authorized official phone:** (713) 297-7000

## Contact information

- **Practice address:** 4135 S BROADWAY AVE, TYLER, TX 75701-8720
- **Practice address phone:** (903) 581-8662
- **Practice address fax:** (903) 581-7808
- **Mailing address:** 4135 S BROADWAY AVE, TYLER, TX 75701-8720
- **Mailing address phone:** (903) 581-8662
- **Mailing address fax:** (903) 581-7808

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 10/07/2008
- **Last updated:** 03/03/2020