Provider Demographics
NPI:1760412472
Name:PEAK PERFORMANCE PT INC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE PT INC
Other - Org Name:PEAK PERFORMANCE PHYSICAL THERAPY & SPORTS REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LENORE
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:FILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, OCS
Authorized Official - Phone:310-544-7325
Mailing Address - Street 1:31228 PALOS VERDES DR W
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-5361
Mailing Address - Country:US
Mailing Address - Phone:310-544-7325
Mailing Address - Fax:310-544-2625
Practice Address - Street 1:31228 PALOS VERDES DR W
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-5361
Practice Address - Country:US
Practice Address - Phone:310-544-7325
Practice Address - Fax:310-544-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA245202251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11585418OtherCAQH PROVIDER ID
CAW19563Medicare ID - Type Unspecified