Provider Demographics
NPI:1073760708
Name:PEAK PERFORMANCE PHYSICAL THERAPY, PLC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE PHYSICAL THERAPY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:703-473-1515
Mailing Address - Street 1:11301 SUNSET HILLS RD
Mailing Address - Street 2:SUITE A3
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5226
Mailing Address - Country:US
Mailing Address - Phone:703-473-1515
Mailing Address - Fax:703-473-8333
Practice Address - Street 1:11301 SUNSET HILLS RD
Practice Address - Street 2:SUITE A3
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5226
Practice Address - Country:US
Practice Address - Phone:703-473-1515
Practice Address - Fax:703-473-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty