Provider Demographics
NPI:1356588693
Name:THREE PEAKS MEDICAL LLC
Entity type:Organization
Organization Name:THREE PEAKS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BALTHAZOR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-928-9646
Mailing Address - Street 1:4145 NEVIS ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-6818
Mailing Address - Country:US
Mailing Address - Phone:303-926-9646
Mailing Address - Fax:
Practice Address - Street 1:4145 NEVIS ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-6818
Practice Address - Country:US
Practice Address - Phone:303-926-9646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty