Provider Demographics
NPI:1730736158
Name:ACHIEVE PERFORMANCE LAB LLC
Entity type:Organization
Organization Name:ACHIEVE PERFORMANCE LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEACHEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:312-620-9915
Mailing Address - Street 1:1940 W LAWRENCE AVE APT 3W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4012
Mailing Address - Country:US
Mailing Address - Phone:763-442-2251
Mailing Address - Fax:
Practice Address - Street 1:1940 W LAWRENCE AVE APT 3W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4012
Practice Address - Country:US
Practice Address - Phone:763-442-2251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy