# PERFORMANCE PHYSICAL MEDICINE

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

## Provider details

- **NPI number:** 1578141818
- **Authorized official:** DR. BRIAN MICHAEL WRAITH DC (PRESIDENT)
- **Authorized official phone:** (914) 661-8444

## Contact information

- **Practice address:** 150 UNION AVE FL 2, EAST RUTHERFORD, NJ 07073-1917
- **Practice address phone:** (201) 414-9545
- **Mailing address:** 323 BERGEN BLVD, FAIRVIEW, NJ 07022-1334
- **Mailing address phone:** (201) 945-9993
- **Mailing address fax:** (201) 945-8873

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | Yes |
| 111N00000X | Chiropractor | — | — | Yes |
| 171100000X | Acupuncturist | — | NULL | — |
| 171100000X | Acupuncturist | — | — | — |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 225700000X | Massage Therapist | — | NULL | — |
| 225700000X | Massage Therapist | — | — | — |

## Other

- **Enumeration date:** 03/30/2021
- **Last updated:** 03/30/2021