Provider Demographics
NPI:1578792370
Name:PEAK PHYSICAL THERAPY AND REHABILITATION LLC
Entity Type:Organization
Organization Name:PEAK PHYSICAL THERAPY AND REHABILITATION LLC
Other - Org Name:PEAK PHYSICAL THERAPY & SPORTS MEDICINE CENTER OF ENNIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-369-8855
Mailing Address - Street 1:2200 PHYSICIANS BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119
Mailing Address - Country:US
Mailing Address - Phone:972-878-1200
Mailing Address - Fax:
Practice Address - Street 1:2200 PHYSICIANS BLVD
Practice Address - Street 2:STE D
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119
Practice Address - Country:US
Practice Address - Phone:972-878-1200
Practice Address - Fax:972-878-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0086SLOtherBCBS
TX206202801Medicaid
TX0086SLOtherBCBS