Active NPI
Peak Performance Physical Therapy PLLC
- Physical Therapy Clinic/Center
- Owego, NY
National Provider Identifier
1295860765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- License
- 011651-1
- Legal business name
- PEAK PERFORMANCE PHYSICAL THERAPY PLLC
- Practice address
- 115 Hickories Park Rd
Owego, NY 13827-4845 - Phone
- (607) 687-7645
- Fax
- (607) 687-7646
- NPI assigned
- Feb 23, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Bryan D Hathaway, PT
- Title
- Owner
- Phone
- (607) 687-7645
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | 011651-1 | NY | Primary |
Addresses
Primary practice location
115 Hickories Park Rd
Owego, NY 13827-4845
Mailing address
115 Hickories Park Rd
Owego, NY 13827-4845
Phone (607) 687-7645
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050825000774 | NY | Part B Supplier - Clinic/Group Practice | 2466483896 |
Receives reassigned benefits from 3 practitioners Practice locations: Owego, NY |
National Provider Directory
National Provider DirectoryLocations
115 Hickories Park Rd
Owego, NY 13827
Phone (607) 687-7645
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physical Therapist
- Burbank, CA
- NPI 1063575090
-
- Physical Therapist
- Cherry Hill, NJ
- NPI 1962787994
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172188800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1566345600000",
"number": "1295860765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 HICKORIES PARK RD",
"city": "OWEGO",
"state": "NY",
"postal_code": "138274845",
"telephone_number": "607-687-7645",
"fax_number": "607-687-7646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 HICKORIES PARK RD",
"city": "OWEGO",
"state": "NY",
"postal_code": "138274845",
"telephone_number": "607-687-7645",
"fax_number": "607-687-7646"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PEAK PERFORMANCE PHYSICAL THERAPY PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-23",
"last_updated": "2019-08-21",
"status": "A",
"authorized_official_last_name": "HATHAWAY",
"authorized_official_first_name": "BRYAN",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "607-687-7645",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "PT"
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "NY",
"license": "011651-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Owego, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.