Organization
PERFORMANCE REHAB, INC
Active
Organization
PERFORMANCE REHAB, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUZANNE S WALTERS OTR L (CEO)
(601) 308-5117
Entity
Organization
Contact information
Practice address
950 EAST COUNTYLINE ROAD, SUITE A, RIDGELAND, MS 39157
(601) 308-5117
(601) 308-5103
Mailing address
PO BOX 720610, BYRAM, MS 39272-0610
(601) 308-5117
(601) 308-5103
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
0524742
MS
261QX0100X
Occupational Medicine Clinic/Center
0524742
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007769666
AETNA PIN #
MS
05
—
09326565
—
MS
Enumeration date
08/23/2005
Last updated
11/16/2017
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up