Basic Information
| Provider Information | |||||||||
| NPI: | 1265165179 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEAK PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 CORPORATE DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352425424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232387217 | ||||||||
| FaxNumber: | 4232383473 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 W INTERSTATE 30 STE F | ||||||||
| Address2: | |||||||||
| City: | ROYSE CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751897513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4695139310 | ||||||||
| FaxNumber: | 2142768367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2022 | ||||||||
| LastUpdateDate: | 07/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | BENETTO | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4232388923 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.