Provider Demographics
NPI:1992871073
Name:PEAK PERFORMANCE REHAB, LLC
Entity type:Organization
Organization Name:PEAK PERFORMANCE REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-764-4242
Mailing Address - Street 1:2310 MALL RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2809
Mailing Address - Country:US
Mailing Address - Phone:256-764-4242
Mailing Address - Fax:256-764-4343
Practice Address - Street 1:2310 MALL RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2809
Practice Address - Country:US
Practice Address - Phone:256-764-4242
Practice Address - Fax:256-764-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3605225100000X
ALPTH3581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529926190Medicaid
AL529926190Medicaid