Provider Demographics
NPI:1306592209
Name:PEAK PHYSICAL THERAPY AND PERFORMANCE TRAINING LLC
Entity type:Organization
Organization Name:PEAK PHYSICAL THERAPY AND PERFORMANCE TRAINING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTAN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:201-873-8406
Mailing Address - Street 1:4050 CANDLE LIGHT DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:MD
Mailing Address - Zip Code:21036-1141
Mailing Address - Country:US
Mailing Address - Phone:201-873-8406
Mailing Address - Fax:
Practice Address - Street 1:4050 CANDLE LIGHT DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:MD
Practice Address - Zip Code:21036-1141
Practice Address - Country:US
Practice Address - Phone:201-873-8406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy