Provider Demographics
NPI:1134192685
Name:PEAK PERFORMANCE SPORTS AND SPINE
Entity type:Organization
Organization Name:PEAK PERFORMANCE SPORTS AND SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MSPT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HUEFNER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:509-453-7325
Mailing Address - Street 1:2505 RACQUET LN
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-6114
Mailing Address - Country:US
Mailing Address - Phone:509-453-7325
Mailing Address - Fax:509-453-7330
Practice Address - Street 1:2505 RACQUET LN
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6114
Practice Address - Country:US
Practice Address - Phone:509-453-7325
Practice Address - Fax:509-453-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2207862Medicaid
WA0202948OtherL&I
WA7130560Medicaid