Healthcare Provider Details

I. General information

NPI: 1992393417
Provider Name (Legal Business Name): PEAK PERFORMANCE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2021
Last Update Date: 01/10/2021
Certification Date: 01/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 E 9 MILE RD
FERNDALE MI
48220-1962
US

IV. Provider business mailing address

344 E HARRY AVE
HAZEL PARK MI
48030-2055
US

V. Phone/Fax

Practice location:
  • Phone: 586-871-4805
  • Fax:
Mailing address:
  • Phone: 586-871-4805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANTWAN FARAJ
Title or Position: OWNER/MEMBER
Credential: DPT
Phone: 586-871-4805