Basic Information
| Provider Information | |||||||||
| NPI: | 1861887069 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEAK PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6397 LEE HWY STE 300 | ||||||||
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| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374214915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232387217 | ||||||||
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| Practice Location | |||||||||
| Address1: | 611 W BROWN ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WYLIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750985316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724425287 | ||||||||
| FaxNumber: | 9724423181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2015 | ||||||||
| LastUpdateDate: | 07/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | JOHANNESON | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 4232388923 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.