Provider Demographics
NPI:1659540474
Name:PEAK PERFORMANCE PHYSICAL THERAPY AND FITNESS LLC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE PHYSICAL THERAPY AND FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:PURVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-295-8183
Mailing Address - Street 1:11320 INDUSTRIPLEX BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-4108
Mailing Address - Country:US
Mailing Address - Phone:225-295-8183
Mailing Address - Fax:225-246-8730
Practice Address - Street 1:11320 INDUSTRIPLEX BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-4108
Practice Address - Country:US
Practice Address - Phone:225-295-8183
Practice Address - Fax:225-246-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6226890001Medicare NSC
LA5C610Medicare UPIN