Provider Demographics
NPI:1992393417
Name:PEAK PERFORMANCE SOLUTIONS LLC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANTWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:586-871-4805
Mailing Address - Street 1:344 E HARRY AVE
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-2055
Mailing Address - Country:US
Mailing Address - Phone:586-871-4805
Mailing Address - Fax:
Practice Address - Street 1:668 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1962
Practice Address - Country:US
Practice Address - Phone:586-871-4805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty