Healthcare Provider Details

I. General information

NPI: 1487139671
Provider Name (Legal Business Name): PEAK PERFORMANCE PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 S HIGHWAY 101
SOLANA BEACH CA
92075-1807
US

IV. Provider business mailing address

247 S HIGHWAY 101
SOLANA BEACH CA
92075-1807
US

V. Phone/Fax

Practice location:
  • Phone: 760-230-5432
  • Fax: 760-655-4336
Mailing address:
  • Phone: 760-230-5432
  • Fax: 760-655-4336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE MCCLEMONS
Title or Position: CEO
Credential: MPT
Phone: 619-920-7873