Provider Demographics
NPI:1205900313
Name:PEAK PERFORMANCE ORTHOPEDIC & SPORTS PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:PEAK PERFORMANCE ORTHOPEDIC & SPORTS PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, CMDT
Authorized Official - Phone:260-244-5133
Mailing Address - Street 1:169 N 200 E
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-8895
Mailing Address - Country:US
Mailing Address - Phone:260-244-5133
Mailing Address - Fax:260-244-5134
Practice Address - Street 1:169 N 200 E
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-8895
Practice Address - Country:US
Practice Address - Phone:260-244-5133
Practice Address - Fax:260-244-5134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN225100000X225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200832220AMedicaid
IN232920Medicare ID - Type Unspecified