Provider Demographics
NPI:1770687956
Name:PEAK PERFORMANCE ORTHOPEDIC PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE ORTHOPEDIC PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:KANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:781-586-0550
Mailing Address - Street 1:173 ESSEX STREET
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907
Mailing Address - Country:US
Mailing Address - Phone:781-586-0550
Mailing Address - Fax:781-586-0125
Practice Address - Street 1:173 ESSEX STREET
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907
Practice Address - Country:US
Practice Address - Phone:781-586-0550
Practice Address - Fax:781-586-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
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
MA694042OtherTUFTS
MA626278OtherHARVARD PILGRIM
MA0396371OtherMASSHEALTH
MA684824OtherUNITED HEALTH CARE
MA626278OtherVANGUARD
MA7518306OtherAETNA
MAY61285OtherBCBS
MA626278OtherVANGUARD