Provider Demographics
NPI:1205810827
Name:PEAK CONDITION LLC
Entity type:Organization
Organization Name:PEAK CONDITION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:702-876-9737
Mailing Address - Street 1:6040 SOUTH RAINBOW BLVD.,
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118
Mailing Address - Country:US
Mailing Address - Phone:702-876-9737
Mailing Address - Fax:702-876-9741
Practice Address - Street 1:6040 SOUTH RAINBOW BLVD.,
Practice Address - Street 2:SUITE B-1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118
Practice Address - Country:US
Practice Address - Phone:702-876-9737
Practice Address - Fax:702-876-9741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NV225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
V100141Medicare UPIN
NVV100141Medicare PIN