Provider Demographics
NPI:1417413923
Name:PEAK PERFORMANCE CARE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE CARE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLORA
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:209-532-1288
Mailing Address - Street 1:PO BOX 4143
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-4143
Mailing Address - Country:US
Mailing Address - Phone:209-532-1288
Mailing Address - Fax:209-230-9529
Practice Address - Street 1:13949 MONO WAY
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-2807
Practice Address - Country:US
Practice Address - Phone:209-532-1288
Practice Address - Fax:209-230-9529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1740420058Medicaid