Provider Demographics
NPI:1306083878
Name:PEAK REHABILITATION, FITNESS AND PERFORMANCE CENTER
Entity type:Organization
Organization Name:PEAK REHABILITATION, FITNESS AND PERFORMANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REHAB/ THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:706-823-3807
Mailing Address - Street 1:1441 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-1048
Mailing Address - Country:US
Mailing Address - Phone:706-726-1718
Mailing Address - Fax:706-823-3810
Practice Address - Street 1:1441 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1048
Practice Address - Country:US
Practice Address - Phone:706-726-1718
Practice Address - Fax:706-823-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G4170526Medicare PIN