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General NPI Number Information
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NPI Number | 1003011537
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Entity Type | Organization
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Legal Business Name | PEAK PERFORMANCE THERAPY LLC
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 08/14/2009
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Provider Practice Location Address
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Address Line | 390 VIRGINIA ST
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City | URBANNA
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State | VA
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Zip | 23175
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Country | US
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Telephone | 804-758-5588
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Fax | 804-758-5589
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Provider Business Mailing Address
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Address Line | 390 VIRGINIA ST B
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City | URBANNA
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State | VA
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Zip | 23175
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Country | US
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Telephone | 804-758-5588
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Fax | 804-758-5589
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Authorized Official
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Title or Position | OWNER
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Name | CAROL A KEENAN
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Credential | PT
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Telephone | 804-758-5588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305003508
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License Number State | VA
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