Provider Demographics
NPI:1124727474
Name:RETRI PERFORMANCE
Entity type:Organization
Organization Name:RETRI PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNOR
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GANZER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:630-437-1487
Mailing Address - Street 1:15960 ASHFORD CT
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-6750
Mailing Address - Country:US
Mailing Address - Phone:630-437-1487
Mailing Address - Fax:
Practice Address - Street 1:15960 ASHFORD CT
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-6750
Practice Address - Country:US
Practice Address - Phone:630-437-1487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty