Organization Name: | PEAK PERFORMANCE PT/MD,LLC |
NPI Number: | 1699164152 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LARRY BERARDUCCI (OWNER) |
Mailing Address: | 540 Mesa Vista Ct Colorado Springs |
State: | CO US |
Postal Code: | 809042541 |
Phone Number: | 7192378241 |
Fax Number: | |
NPI Enumeration Date: | 01/21/2015 |
NPI Last Update Date: | 01/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 51214 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |