Provider Demographics
NPI:1386528412
Name:PEAK POTENTIAL PHYSICAL THERAPY
Entity type:Organization
Organization Name:PEAK POTENTIAL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURETTA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RUSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CCI
Authorized Official - Phone:949-295-9675
Mailing Address - Street 1:11 CALLE DE ARENA
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2870
Mailing Address - Country:US
Mailing Address - Phone:949-295-9675
Mailing Address - Fax:
Practice Address - Street 1:11 CALLE DE ARENA
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2870
Practice Address - Country:US
Practice Address - Phone:949-295-9675
Practice Address - Fax:949-325-9644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEAK POTENTIAL PHYSICAL THERAPY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy