Provider Demographics
NPI:1851419436
Name:DIAMOND PEAK PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:DIAMOND PEAK PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODRIGO
Authorized Official - Middle Name:
Authorized Official - Last Name:GIL MORENO DE MORA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:970-593-1442
Mailing Address - Street 1:1542 TAURUS CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-3280
Mailing Address - Country:US
Mailing Address - Phone:970-593-1442
Mailing Address - Fax:970-667-1740
Practice Address - Street 1:1542 TAURUS CT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3280
Practice Address - Country:US
Practice Address - Phone:970-593-1442
Practice Address - Fax:970-667-1740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO62852251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64454720Medicaid
CO475058Medicare ID - Type Unspecified