Provider Demographics
NPI:1669639043
Name:PEAK MOTION PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PEAK MOTION PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:BACA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:505-797-5505
Mailing Address - Street 1:8100 WYOMING BLVD NE STE M4
Mailing Address - Street 2:261
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1963
Mailing Address - Country:US
Mailing Address - Phone:505-797-5505
Mailing Address - Fax:505-797-5510
Practice Address - Street 1:7424 HOLLY AVE. NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113
Practice Address - Country:US
Practice Address - Phone:505-797-5505
Practice Address - Fax:505-797-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2401261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy