Organization
PERFORMANCE PHYSICAL THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAREN L HASELTINE (C.E.O.)
(904) 824-7787
Entity
Organization
Contact information
Practice address
150 SOUTHPARK BLVD, SUITE 201, ST AUGUSTINE, FL 32086-5190
(904) 824-7787
(904) 429-0318
Mailing address
150 SOUTHPARK BLVD, SUITE 201, ST AUGUSTINE, FL 32086-5190
(904) 824-7787
(904) 429-0318
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT21013
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
QV9
BLUE CROSS
—
Enumeration date
09/25/2006
Last updated
01/15/2009
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