Provider Demographics
NPI:1780896605
Name:PEAK PHYSICAL THERAPY AND SPORTS MEDICINE CENTER OF RICHARDSON PLLC
Entity type:Organization
Organization Name:PEAK PHYSICAL THERAPY AND SPORTS MEDICINE CENTER OF RICHARDSON PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MCGINTY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-994-0434
Mailing Address - Street 1:1840 N GREENVILLE AVE STE 156
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-1874
Mailing Address - Country:US
Mailing Address - Phone:972-994-0434
Mailing Address - Fax:972-994-0438
Practice Address - Street 1:1840 N GREENVILLE AVE STE 156
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1874
Practice Address - Country:US
Practice Address - Phone:972-994-0434
Practice Address - Fax:972-994-0438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1035285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0078HCOtherBCBS
TX1035285OtherCIGNA
TX1035285OtherAETNA
TX0A3461OtherMEDICARE PTAN