Organization
PERFORMANCE PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARRIN E LARSEN P.T. (OWNER)
(480) 756-8617
Entity
Organization
Contact information
Practice address
8725 S KYRENE RD, STE 106, TEMPE, AZ 85284-2116
(480) 756-8617
(480) 820-9909
Mailing address
8725 S KYRENE RD, STE 106, TEMPE, AZ 85284-2116
(480) 756-8617
(480) 820-9909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5457
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2Z2989
HEALTHNET
AZ
01
—
318389
ARIZONA HEALTHCARE COST CONTAINMENT SYSTEM (AHCCCS)
AZ
01
—
DF6555
RR MEDICARE
AZ
Enumeration date
08/30/2006
Last updated
05/23/2008
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