Basic Information
| Provider Information | |||||||||
| NPI: | 1366656977 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEAK PHYSICAL THERAPY & SPORTS MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 LEGACY DR | ||||||||
| Address2: | #118 | ||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723774111 | ||||||||
| FaxNumber: | 9723774148 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 LEGACY DR | ||||||||
| Address2: | #118 | ||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723774111 | ||||||||
| FaxNumber: | 9723774148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ESTES | ||||||||
| AuthorizedOfficialFirstName: | JAY | ||||||||
| AuthorizedOfficialMiddleName: | RANDALL | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 9723774111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1098663 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.