Provider Demographics
NPI:1679835102
Name:WINDY PEAK WELLNESS
Entity Type:Organization
Organization Name:WINDY PEAK WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:REESMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:303-442-8728
Mailing Address - Street 1:405 URBAN ST STE 320
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1222
Mailing Address - Country:US
Mailing Address - Phone:303-442-8728
Mailing Address - Fax:
Practice Address - Street 1:405 URBAN ST STE 320
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1222
Practice Address - Country:US
Practice Address - Phone:303-442-8728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO128299261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service