Provider Demographics
NPI:1790262715
Name:PEAK THERAPY LLC
Entity Type:Organization
Organization Name:PEAK THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT,DPT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:NEW-JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:928-310-0947
Mailing Address - Street 1:8380 N FLEMING DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-6247
Mailing Address - Country:US
Mailing Address - Phone:928-310-0947
Mailing Address - Fax:
Practice Address - Street 1:8380 N FLEMING DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-6247
Practice Address - Country:US
Practice Address - Phone:928-310-0947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X, 225X00000X, 261QP2000X
AZ6768225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy