Provider Demographics
NPI:1457184889
Name:PEAK PERFORMANCE HEALTH CLINIC, PLLC
Entity type:Organization
Organization Name:PEAK PERFORMANCE HEALTH CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THOMASA
Authorized Official - Middle Name:
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:615-910-7325
Mailing Address - Street 1:1273 NORTHFIELD DR STE 2
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6184
Mailing Address - Country:US
Mailing Address - Phone:615-910-7325
Mailing Address - Fax:
Practice Address - Street 1:1273 NORTHFIELD DR STE 2
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6184
Practice Address - Country:US
Practice Address - Phone:615-910-7325
Practice Address - Fax:832-621-0429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty