Provider Demographics
NPI:1316071103
Name:QUALITY PERFORMANCE REHABILITATION, INC.
Entity type:Organization
Organization Name:QUALITY PERFORMANCE REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P., OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:772-873-8980
Mailing Address - Street 1:441 NW PRIMA VISTA BLVD.
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983
Mailing Address - Country:US
Mailing Address - Phone:772-873-8980
Mailing Address - Fax:772-873-8981
Practice Address - Street 1:441 NW PRIMA VISTA BLVD.
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983
Practice Address - Country:US
Practice Address - Phone:772-873-8980
Practice Address - Fax:772-873-8981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY917ZOtherBCBS GROUP
FL889016100Medicaid
FLY0235ZMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
FL889016100Medicaid
FLU0374YMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
FLY917ZOtherBCBS GROUP
FLY056EZMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
FLY7973AMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL