Provider Demographics
NPI:1457377046
Name:PEAK PERFORMANCE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUGAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:207-989-7325
Mailing Address - Street 1:401 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-2322
Mailing Address - Country:US
Mailing Address - Phone:207-989-7325
Mailing Address - Fax:207-989-7326
Practice Address - Street 1:401 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-2322
Practice Address - Country:US
Practice Address - Phone:207-989-7325
Practice Address - Fax:207-989-7326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT 1571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME206533Medicare Oscar/Certification