1669909693 NPI number — PEAK REHABILITATION, FITNESS AND PERFORMANCE CENTER LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669909693 NPI number — PEAK REHABILITATION, FITNESS AND PERFORMANCE CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEAK REHABILITATION, FITNESS AND PERFORMANCE CENTER 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:
Provider Other Organization Name Type Code:
6
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:
1669909693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 DANTIGNAC ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30901-2774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-922-6561
Provider Business Mailing Address Fax Number:
706-823-3810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 SILVER BLUFF RD STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIKEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29803-6038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-220-3655
Provider Business Practice Location Address Fax Number:
803-226-0045
Provider Enumeration Date:
05/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BONE
Authorized Official First Name:
SALLY
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
INSURANCE & CREDENTIALING MANAGER
Authorized Official Telephone Number:
844-273-4607

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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