Provider Demographics
NPI:1386688166
Name:PEAK REHABILITATION OF DENVER LLC
Entity Type:Organization
Organization Name:PEAK REHABILITATION OF DENVER LLC
Other - Org Name:PEAK PHYSICAL THERAPY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-840-7325
Mailing Address - Street 1:16522 KEYSTONE BLVD
Mailing Address - Street 2:SUITE N
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3302
Mailing Address - Country:US
Mailing Address - Phone:303-840-7325
Mailing Address - Fax:303-840-7326
Practice Address - Street 1:16522 KEYSTONE BLVD
Practice Address - Street 2:SUITE N
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3302
Practice Address - Country:US
Practice Address - Phone:303-840-7325
Practice Address - Fax:303-840-7326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066638Medicare Oscar/Certification