Provider Demographics
NPI: | 1811018914 |
---|---|
Name: | PEAK FORM LLC |
Entity Type: | Organization |
Organization Name: | PEAK FORM LLC |
Other - Org Name: | PEAK FORM PHYSICAL THERAPY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JEANETTE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HRUBES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 720-939-1058 |
Mailing Address - Street 1: | 1093 E BRIDGE ST |
Mailing Address - Street 2: | |
Mailing Address - City: | BRIGHTON |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80601-2252 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 720-939-1058 |
Mailing Address - Fax: | 303-655-0063 |
Practice Address - Street 1: | 1093 E BRIDGE ST |
Practice Address - Street 2: | |
Practice Address - City: | BRIGHTON |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80601-2252 |
Practice Address - Country: | US |
Practice Address - Phone: | 720-939-1058 |
Practice Address - Fax: | 303-655-0063 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-04-03 |
Last Update Date: | 2020-07-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 224Y00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Clinical Exercise Physiologist | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363LX0106X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Occupational Health | Group - Multi-Specialty |