Healthcare Provider Details

I. General information

NPI: 1760412472
Provider Name (Legal Business Name): PEAK PERFORMANCE PT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31228 PALOS VERDES DR W
RANCHO PALOS VERDES CA
90275-5361
US

IV. Provider business mailing address

31228 PALOS VERDES DR W
RANCHO PALOS VERDES CA
90275-5361
US

V. Phone/Fax

Practice location:
  • Phone: 310-544-7325
  • Fax: 310-544-2625
Mailing address:
  • Phone: 310-544-7325
  • Fax: 310-544-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number24520
License Number StateCA

VIII. Authorized Official

Name: MS. LENORE ESTHER FILLER
Title or Position: OWNER
Credential: MPT, OCS
Phone: 310-544-7325