Provider Demographics
NPI:1528260221
Name:PERFORMANCE THERAPEUTICS RIO GRANDECITY PLLC
Entity type:Organization
Organization Name:PERFORMANCE THERAPEUTICS RIO GRANDECITY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PALOMIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:956-687-4559
Mailing Address - Street 1:2101 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6127
Mailing Address - Country:US
Mailing Address - Phone:956-687-4559
Mailing Address - Fax:956-618-1342
Practice Address - Street 1:101 N FM 3167 STE 105
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-6776
Practice Address - Country:US
Practice Address - Phone:956-488-1999
Practice Address - Fax:956-488-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1139541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613041800OtherWORKERS' COMPENSATION
TX0098QAOtherBC/BS PROVIDER #
TXP95120Medicare UPIN
TX00X990Medicare PIN