Provider Demographics
NPI:1407696362
Name:PERFORMANCE PAIN AND SPORTS MEDICINE, PLLC
Entity type:Organization
Organization Name:PERFORMANCE PAIN AND SPORTS MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:346-217-1111
Mailing Address - Street 1:PO BOX 649834
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75264-9834
Mailing Address - Country:US
Mailing Address - Phone:346-308-6741
Mailing Address - Fax:346-571-2189
Practice Address - Street 1:1216 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-7463
Practice Address - Country:US
Practice Address - Phone:346-217-1111
Practice Address - Fax:346-571-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies