MEDICARE: PEAK PERFORMANCE SPORTS MEDICINE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1942411152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK PERFORMANCE SPORTS MEDICINE, LLC

Provider Business Mailing Address
First Line	:	3121 E DIANE DR
Second Line	:
City	:	OAK CREEK
State	:	WI
Zip	:	53154-3483
Country	:	US
Telephone Number	:	414-852-4022
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 N 16TH ST
Second Line	:	DEPT. OF EX. SCIENCE, CRAMER HALL 215
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-2117
Country	:	US
Telephone Number	:	414-852-4022
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY SISCHO
Credential	:	PT, LAT, DPT, CSCS
Telephone Number	:	414-852-4022

Provider Enumeration Date	:	05/28/2007
Last Update Date	:	09/11/2025

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