Organization
PERFORMANCE PLUS REHABILITATION CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA THERESE SMITH (OFFICE MANAGER)
(816) 232-5113
Entity
Organization
Contact information
Practice address
1802 N WOODBINE RD., ST. JOSEPH, MO 64506
(816) 232-5113
(816) 232-0453
Mailing address
PO BOX 6423, ST. JOSEPH, MO 64506
(816) 232-5113
(816) 232-0453
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CE006171
MO
111NR0400X
Rehabilitation Chiropractor
CE006171
MO
225100000X
Physical Therapist
2002011893
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20689030
BCBS
MO
05
—
757861505
—
MO
Enumeration date
05/03/2007
Last updated
03/21/2012
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