Provider Demographics
NPI:1073551560
Name:PEAK PHYSICAL THERAPY P C
Entity Type:Organization
Organization Name:PEAK PHYSICAL THERAPY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:208-375-0666
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:812-628-3060
Mailing Address - Fax:208-375-2996
Practice Address - Street 1:7550 W EMERALD ST # 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9015
Practice Address - Country:US
Practice Address - Phone:208-375-0666
Practice Address - Fax:208-375-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2022-10-27
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
ID806711000Medicaid
IDCK8839OtherRAIL ROAD MEDICARE
ID000010142952OtherBLUE SHIELD OF IDAHO
IDT8059OtherBLUE CROSS OF IDAHO
CO809211Medicare PIN