Healthcare Provider Details

I. General information

NPI: 1134428642
Provider Name (Legal Business Name): PEAK PERFORMANCE PHYSICAL THERAPY, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7402 WESTSHIRE DR STE 105
LANSING MI
48917
US

IV. Provider business mailing address

7402 WESTSHIRE DR STE 105
LANSING MI
48917-8687
US

V. Phone/Fax

Practice location:
  • Phone: 517-853-6800
  • Fax: 517-853-6801
Mailing address:
  • Phone: 517-853-6800
  • Fax: 517-853-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JILL MARLAN
Title or Position: OWNER
Credential:
Phone: 517-281-8586