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General NPI Number Information
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NPI Number | 1659638567
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Entity Type | Organization
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Legal Business Name | PEAK PERFORMANCE PHYSICAL THERAPY AND SPORTS MEDICINE LLC
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Dates
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Enumeration Date | 04/16/2012
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Last Update Date | 01/17/2014
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Provider Practice Location Address
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Address Line | 965 MASSACHUSETTS AVE SUITE 102
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City | ARLINGTON
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State | MA
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Zip | 02476-4510
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Country | US
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Telephone | 617-828-5617
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Fax |
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Provider Business Mailing Address
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Address Line | 965 MASSACHUSETTS AVE SUITE 102
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City | ARLINGTON
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State | MA
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Zip | 02476-4510
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Country | US
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Telephone | 617-828-5617
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | MICHAEL PELLEGRINO
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Credential | DPT, CSCS
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Telephone | 617-828-5617
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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 | 97063
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License Number State |
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