1073760708 NPI number — PEAK PERFORMANCE PHYSICAL THERAPY, PLC

Table of content: (NPI 1073760708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073760708 NPI number — PEAK PERFORMANCE PHYSICAL THERAPY, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEAK PERFORMANCE PHYSICAL THERAPY, PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073760708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11301 SUNSET HILLS RD
Provider Second Line Business Mailing Address:
SUITE A3
Provider Business Mailing Address City Name:
RESTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20190-5226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-473-1515
Provider Business Mailing Address Fax Number:
703-473-8333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11301 SUNSET HILLS RD
Provider Second Line Business Practice Location Address:
SUITE A3
Provider Business Practice Location Address City Name:
RESTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20190-5226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-473-1515
Provider Business Practice Location Address Fax Number:
703-473-8333
Provider Enumeration Date:
08/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BURTON
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
CO-MANAGER
Authorized Official Telephone Number:
703-473-1515

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305001612 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com