# PEAK PHYSICAL THERAPY SPORTS AND PERFORMANCE CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Poulin Performance and Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184057143
- **Authorized official:** MS. SUSAN DODGE PT (PRESIDENT)
- **Authorized official phone:** (802) 658-0949

## Contact information

- **Practice address:** 21 GREGORY DR, SOUTH BURLINGTON, VT 05403-6080
- **Practice address phone:** (802) 658-0949
- **Mailing address:** 21 GREGORY DR, SOUTH BURLINGTON, VT 05403-6080
- **Mailing address phone:** (802) 658-0949

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | 040.0002127 | VT | Yes |

## Other

- **Enumeration date:** 08/14/2013
- **Last updated:** 10/16/2013