Organization
PERFORMANCE SPINE & SPORTS SPECIALISTS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAWN DALTON-BETHEA M.D. (PRESIDENT)
(336) 501-3796
Entity
Organization
Contact information
Practice address
1507 WESTOVER TER STE B, SUITE A, GREENSBORO, NC 27408-7121
(336) 501-3796
(336) 333-5477
Mailing address
PO BOX 38728, GREENSBORO, NC 27438-8728
(336) 501-3796
(336) 333-5477
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5909458
—
NC
Enumeration date
05/25/2010
Last updated
12/01/2014
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