Basic Information
| Provider Information | |||||||||
| NPI: | 1760524607 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEAK PHYSICAL THERAPY AND SPORTS MEDICINE CENTERS OF FORNEY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 E. US HIGHWAY 80 | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | FORNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725643390 | ||||||||
| FaxNumber: | 9725643399 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 E. US HIGHWAY 80 | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | FORNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725643390 | ||||||||
| FaxNumber: | 9725643399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 06/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | ADAMS | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINIC DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9725643390 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PT, MPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1155770 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.