Provider Demographics
NPI:1639949902
Name:PEAK REHAB, LLC
Entity Type:Organization
Organization Name:PEAK REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOLLIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PATHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:919-943-9449
Mailing Address - Street 1:1031 BELLENDEN DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9283
Mailing Address - Country:US
Mailing Address - Phone:919-943-9449
Mailing Address - Fax:
Practice Address - Street 1:3400 WESTGATE DR STE B14C
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2696
Practice Address - Country:US
Practice Address - Phone:984-833-2535
Practice Address - Fax:919-313-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1912555384Medicaid