Provider Demographics
NPI:1942411152
Name:PEAK PERFORMANCE SPORTS MEDICINE, LLC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SISCHO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, LAT, DPT, CSCS
Authorized Official - Phone:414-852-4022
Mailing Address - Street 1:3121 E DIANE DR
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-3483
Mailing Address - Country:US
Mailing Address - Phone:414-852-4022
Mailing Address - Fax:
Practice Address - Street 1:604 N 16TH ST
Practice Address - Street 2:DEPT. OF EX. SCIENCE, CRAMER HALL 215
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2117
Practice Address - Country:US
Practice Address - Phone:414-852-4022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Not Answered261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation