Provider Demographics
NPI:1053441634
Name:PEAK PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:PEAK PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:I
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:970-522-7743
Mailing Address - Street 1:427 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-3033
Mailing Address - Country:US
Mailing Address - Phone:970-522-7743
Mailing Address - Fax:970-522-8835
Practice Address - Street 1:190 TALISMAN DR
Practice Address - Street 2:UNIT D4
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-9171
Practice Address - Country:US
Practice Address - Phone:970-731-1888
Practice Address - Fax:970-731-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPE647283OtherBLUE CROSS
COPE647283OtherBLUE CROSS