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General NPI Number Information
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NPI Number | 1871081158
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Entity Type | Organization
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Legal Business Name | PEAK PERFORMANCE
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 05/03/2018
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Provider Practice Location Address
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Address Line | 821 BURLINGTON AVE LOWR LEVEL
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City | WESTERN SPRINGS
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State | IL
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Zip | 60558-1287
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Country | US
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Telephone | 708-261-8458
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Fax |
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Provider Business Mailing Address
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Address Line | 821 WEST BURLINGTON AVE LOWR LEVEL
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City | WESTERN SPRINGS
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State | IL
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Zip | 60558-1287
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Country | US
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Telephone | 708-261-8458
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | JONATHAN LOOS
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Credential | PT
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Telephone | 630-514-9199
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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 | 070020116
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License Number State | IL
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