1356660690 NPI number — PEAK PERFORMANCE REHABILITATION, LLC

Table of content: (NPI 1356660690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356660690 NPI number — PEAK PERFORMANCE REHABILITATION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEAK PERFORMANCE REHABILITATION, LLC
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:
N/A
Provider Other Organization Name Type Code:
3
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:
1356660690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
632 N FEDERAL HIGHWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-929-3006
Provider Business Mailing Address Fax Number:
954-929-2001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 SE 20TH ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33316-3589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-302-7717
Provider Business Practice Location Address Fax Number:
754-216-2749
Provider Enumeration Date:
05/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
954-302-7717

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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