NPIMap

Organization Active NPI

Peak Performance Physical Therapy and Sports Medicine LLC

  • Physical Therapist
  • Arlington, MA
National Provider Identifier
1659638567
Registry record updated Jan 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
97063
Legal business name
PEAK PERFORMANCE PHYSICAL THERAPY AND SPORTS MEDICINE LLC
Practice address
965 Massachusetts Ave
Suite 102
Arlington, MA 02476-4510
Phone
(617) 828-5617
NPI assigned
Apr 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Pellegrino, DPT, CSCSNPI 1891016853
Title
Owner/Physical Therapist
Phone
(617) 828-5617

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)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 97063 Primary

Addresses

Primary practice location

965 Massachusetts Ave
Suite 102
Arlington, MA 02476-4510

Mailing address

965 Massachusetts Ave
Suite 102
Arlington, MA 02476-4510
Phone (617) 828-5617

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140729000025 MA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5294951281 Receives reassigned benefits from 6 practitioners
Practice locations: Boston, MA; Arlington, MA

National Provider Directory

National Provider Directory

Locations

26 Massachusetts Ave
Arlington, MA 02474
Phone (617) 828-5617

965 Massachusetts Ave
Ste 102
Arlington, MA 02476
Phone (617) 828-5617

965 Massachusetts Ave
Arlington, MA 02476
Phone (617) 828-5617

400 Commonwealth Ave
Ste G2
Boston, MA 02215

400 Commonwealth Ave
#G2
Boston, MA 02215
Phone (617) 828-5617

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389916800000",
    "number": "1659638567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 MASSACHUSETTS AVE",
            "address_2": "SUITE 102",
            "city": "ARLINGTON",
            "state": "MA",
            "postal_code": "024764510",
            "telephone_number": "617-828-5617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 MASSACHUSETTS AVE",
            "address_2": "SUITE 102",
            "city": "ARLINGTON",
            "state": "MA",
            "postal_code": "024764510",
            "telephone_number": "617-828-5617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK PERFORMANCE PHYSICAL THERAPY AND SPORTS MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-16",
        "last_updated": "2014-01-17",
        "status": "A",
        "authorized_official_last_name": "PELLEGRINO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "617-828-5617",
        "authorized_official_credential": "DPT, CSCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": "97063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; 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.

Verify at the official NPI Registry.