Provider Demographics
NPI:1871043174
Name:PEAK PERFORMANCE PHYSICAL THERAPY WELLNESS, LLC
Entity type:Organization
Organization Name:PEAK PERFORMANCE PHYSICAL THERAPY WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:EISENHUT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-527-2267
Mailing Address - Street 1:12 BENTON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-6602
Mailing Address - Country:US
Mailing Address - Phone:315-527-2267
Mailing Address - Fax:315-734-9602
Practice Address - Street 1:3 MILL STREET
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2652
Practice Address - Country:US
Practice Address - Phone:315-527-2267
Practice Address - Fax:315-734-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025162-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty