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General NPI Number Information
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NPI Number | 1871043174
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Entity Type | Organization
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Legal Business Name | PEAK PERFORMANCE PHYSICAL THERAPY WELLNESS, LLC
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 3 MILL STREET
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City | NEW HARTFORD
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State | NY
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Zip | 13413-2652
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Country | US
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Telephone | 315-527-2267
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Fax | 315-734-9602
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Provider Business Mailing Address
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Address Line | 12 BENTON CIRCLE
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City | UTICA
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State | NY
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Zip | 13501-6602
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Country | US
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Telephone | 315-527-2267
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Fax | 315-734-9602
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DR. CARY MICHAEL EISENHUT
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Credential | P.T.
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Telephone | 315-527-2267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 025162-1
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License Number State | NY
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