Provider Demographics
NPI:1871081158
Name:PEAK PERFORMANCE
Entity type:Organization
Organization Name:PEAK PERFORMANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-514-9199
Mailing Address - Street 1:821 WEST BURLINGTON AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1287
Mailing Address - Country:US
Mailing Address - Phone:708-261-8458
Mailing Address - Fax:
Practice Address - Street 1:821 BURLINGTON AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1287
Practice Address - Country:US
Practice Address - Phone:708-261-8458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1336573591OtherMEDICARE