Healthcare Provider Details

I. General information

NPI: 1780617431
Provider Name (Legal Business Name): PEAK PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 NORTH ST
NEWBURGH NY
12550-3131
US

IV. Provider business mailing address

260 NORTH ST
NEWBURGH NY
12550-3131
US

V. Phone/Fax

Practice location:
  • Phone: 845-565-5054
  • Fax: 845-565-4071
Mailing address:
  • Phone: 845-565-5054
  • Fax: 845-565-4071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number8709
License Number StateNY

VIII. Authorized Official

Name: DANIEL J FISHMAN
Title or Position: PHYSICAL THERAPIST/DIRECTOR
Credential: PT, CHT, MTC
Phone: 845-565-5054