Provider Demographics
NPI:1831220037
Name:PEAK PERFORMANCE REHABILITATION, INC
Entity type:Organization
Organization Name:PEAK PERFORMANCE REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:GALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:423-346-7333
Mailing Address - Street 1:950 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WARTBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37887-4309
Mailing Address - Country:US
Mailing Address - Phone:423-346-7333
Mailing Address - Fax:423-346-7337
Practice Address - Street 1:950 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-4309
Practice Address - Country:US
Practice Address - Phone:423-346-7333
Practice Address - Fax:423-346-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3729256Medicaid
TN3729256Medicaid