Provider Demographics
NPI:1730105008
Name:PEAK PERFORMANCE PHYSICAL THERAPY & SPORTS MEDICINE, INC.
Entity Type:Organization
Organization Name:PEAK PERFORMANCE PHYSICAL THERAPY & SPORTS MEDICINE, INC.
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:BUISNESS OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:STURTEVANT
Authorized Official - Suffix:
Authorized Official - Credentials:PT,OCS
Authorized Official - Phone:920-738-0671
Mailing Address - Street 1:2901 E ENTERPRISE AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7401
Mailing Address - Country:US
Mailing Address - Phone:920-738-0671
Mailing Address - Fax:920-738-0773
Practice Address - Street 1:2901 E ENTERPRISE AVE STE 600
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7401
Practice Address - Country:US
Practice Address - Phone:920-738-0671
Practice Address - Fax:920-738-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2022-04-20
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
WI=========012OtherBC/BS
WI=========012OtherBC/BS