Basic Information
| Provider Information | |||||||||
| NPI: | 1770687956 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PEAK PERFORMANCE ORTHOPEDIC PHYSICAL THERAPY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 173 ESSEX STREET | ||||||||
| Address2: | |||||||||
| City: | SWAMPSCOTT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815860550 | ||||||||
| FaxNumber: | 7815860125 | ||||||||
| Practice Location | |||||||||
| Address1: | 173 ESSEX STREET | ||||||||
| Address2: | |||||||||
| City: | SWAMPSCOTT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815860550 | ||||||||
| FaxNumber: | 7815860125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KANTOR | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 7815860550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PT DPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 694042 | 01 | MA | TUFTS | OTHER | 626278 | 01 | MA | HARVARD PILGRIM | OTHER | 0396371 | 01 | MA | MASSHEALTH | OTHER | 684824 | 01 | MA | UNITED HEALTH CARE | OTHER | 626278 | 01 | MA | VANGUARD | OTHER | 7518306 | 01 | MA | AETNA | OTHER | Y61285 | 01 | MA | BCBS | OTHER |