Healthcare Provider Details

I. General information

NPI: 1275838476
Provider Name (Legal Business Name): PEAK PERFORMANCE CARE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADFORD ST
SONORA CA
95370-4701
US

IV. Provider business mailing address

PO BOX 4143
SONORA CA
95370-4143
US

V. Phone/Fax

Practice location:
  • Phone: 209-532-1288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number35312
License Number StateCA

VIII. Authorized Official

Name: ELLORA WESTON
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: DPT
Phone: 209-532-1288