Provider Demographics
NPI:1114758158
Name:SHIFT PEAK PERFORMANCE LLC
Entity type:Organization
Organization Name:SHIFT PEAK PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:REED
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:HANDLERY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:618-210-7933
Mailing Address - Street 1:9515 SHIRE VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-5015
Mailing Address - Country:US
Mailing Address - Phone:618-210-7933
Mailing Address - Fax:
Practice Address - Street 1:6911 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916
Practice Address - Country:US
Practice Address - Phone:618-210-7933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy