Basic Information
| Provider Information | |||||||||
| NPI: | 1003938952 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PEAK REHABILITATION INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | PEAK REHAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 430 S LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | FLOYD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240912322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407455005 | ||||||||
| FaxNumber: | 5407455004 | ||||||||
| Practice Location | |||||||||
| Address1: | 430 S LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | FLOYD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240912322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407455005 | ||||||||
| FaxNumber: | 5407455004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 10/26/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PEAK | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 5407455005 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305005662 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | DC8612 | 01 | VA | RAILROAD MEDICARE | OTHER |