Healthcare Provider Details

I. General information

NPI: 1689118820
Provider Name (Legal Business Name): PEAK PERFORMANCE REHAB,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MARKET SQ
ROGERSVILLE AL
35652-8008
US

IV. Provider business mailing address

PO BOX 869
ROGERSVILLE AL
35652-0869
US

V. Phone/Fax

Practice location:
  • Phone: 256-247-5000
  • Fax:
Mailing address:
  • Phone: 256-764-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY LANDERS
Title or Position: OFFICE ADMIN
Credential:
Phone: 256-764-4242