Basic Information
| Provider Information | |||||||||
| NPI: | 1073551560 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEAK PHYSICAL THERAPY P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 LYNDON FARM CT STE 300 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402235005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126283060 | ||||||||
| FaxNumber: | 2083752996 | ||||||||
| Practice Location | |||||||||
| Address1: | 7550 W EMERALD ST # 101 | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837049015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083750666 | ||||||||
| FaxNumber: | 2083752996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | TUCKER | ||||||||
| AuthorizedOfficialFirstName: | DARIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2083750666 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PTA | ||||||||
| NPICertificationDate: | 10/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 806711000 | 05 | ID | MEDICAID | CK8839 | 01 | ID | RAIL ROAD MEDICARE | OTHER | 000010142952 | 01 | ID | BLUE SHIELD OF IDAHO | OTHER | T8059 | 01 | ID | BLUE CROSS OF IDAHO | OTHER |