Provider Demographics
NPI:1508860909
Name:PEAK PHYSICAL THERAPY & WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:PEAK PHYSICAL THERAPY & WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:970-663-3302
Mailing Address - Street 1:231 W 67TH CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-1177
Mailing Address - Country:US
Mailing Address - Phone:970-663-3302
Mailing Address - Fax:970-663-5255
Practice Address - Street 1:231 W 67TH CT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-1177
Practice Address - Country:US
Practice Address - Phone:970-663-3302
Practice Address - Fax:970-663-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC513858Medicare PIN