Provider Demographics
NPI:1952415002
Name:PEAK PERFORMANCE, INC.
Entity Type:Organization
Organization Name:PEAK PERFORMANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LABELLA
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CD-N
Authorized Official - Phone:860-767-1535
Mailing Address - Street 1:1 EAGLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1330
Mailing Address - Country:US
Mailing Address - Phone:860-767-1535
Mailing Address - Fax:
Practice Address - Street 1:1 EAGLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1330
Practice Address - Country:US
Practice Address - Phone:860-767-1535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT544133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2700005440CT02OtherANTHEM GROUP NUMBER