Provider Demographics
NPI:1770294951
Name:PEAK BALANCE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:PEAK BALANCE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NEENA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:240-712-8697
Mailing Address - Street 1:403 BEN OAKS DR W
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2208
Mailing Address - Country:US
Mailing Address - Phone:240-712-8697
Mailing Address - Fax:443-645-0716
Practice Address - Street 1:403 BEN OAKS DR W
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2208
Practice Address - Country:US
Practice Address - Phone:240-712-8697
Practice Address - Fax:443-645-0716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2023-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy