Provider Demographics
NPI:1679858591
Name:PEAK FITNESS AND PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:PEAK FITNESS AND PHYSICAL THERAPY, PLLC
Other - Org Name:PEAK FITNESS AND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WYKLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, SCS
Authorized Official - Phone:423-468-4067
Mailing Address - Street 1:PO BOX 4744
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-0744
Mailing Address - Country:US
Mailing Address - Phone:423-468-4067
Mailing Address - Fax:
Practice Address - Street 1:1915 BROAD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-1716
Practice Address - Country:US
Practice Address - Phone:423-468-4067
Practice Address - Fax:423-370-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty