Provider Demographics
NPI:1487139671
Name:PEAK PERFORMANCE PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:PEAK PERFORMANCE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:619-920-7873
Mailing Address - Street 1:247 S HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1807
Mailing Address - Country:US
Mailing Address - Phone:760-230-5432
Mailing Address - Fax:760-655-4336
Practice Address - Street 1:247 S HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1807
Practice Address - Country:US
Practice Address - Phone:760-230-5432
Practice Address - Fax:760-655-4336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty