Healthcare Provider Details

I. General information

NPI: 1902586845
Provider Name (Legal Business Name): PEAK PERFORMANCE MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 LAFAYETTE RD UNIT 6
SEABROOK NH
03874-4541
US

IV. Provider business mailing address

270 LAFAYETTE RD UNIT 6
SEABROOK NH
03874-4541
US

V. Phone/Fax

Practice location:
  • Phone: 603-474-9990
  • Fax: 603-474-9996
Mailing address:
  • Phone: 603-474-9990
  • Fax: 603-474-9996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TYLER D LAMSON
Title or Position: OWNER
Credential: DC, AGACNP-BC
Phone: 603-474-9990