Healthcare Provider Details

I. General information

NPI: 1306592209
Provider Name (Legal Business Name): PEAK PHYSICAL THERAPY AND PERFORMANCE TRAINING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 CANDLE LIGHT DR
DAYTON MD
21036-1141
US

IV. Provider business mailing address

4050 CANDLE LIGHT DR
DAYTON MD
21036-1141
US

V. Phone/Fax

Practice location:
  • Phone: 201-873-8406
  • Fax:
Mailing address:
  • Phone: 201-873-8406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KRISTAN LEIGH FISH
Title or Position: OWNER
Credential: DPT
Phone: 201-873-8406