Provider Demographics
NPI:1275667768
Name:PEAK PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PEAK PHYSICAL THERAPY
Other - Org Name:GALENA SPORT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DERECK
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-384-1400
Mailing Address - Street 1:16560 WEDGE PKWY STE 200A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-3318
Mailing Address - Country:US
Mailing Address - Phone:775-384-1400
Mailing Address - Fax:775-384-1367
Practice Address - Street 1:16560 WEDGE PKWY STE 200A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3318
Practice Address - Country:US
Practice Address - Phone:775-384-1400
Practice Address - Fax:775-384-1367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2023-02-16
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
NVV33110Medicare ID - Type UnspecifiedGROUP MEDICARE #