1578792370 NPI number — PEAK PHYSICAL THERAPY AND REHABILITATION LLC

Table of content: (NPI 1578792370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578792370 NPI number — PEAK PHYSICAL THERAPY AND REHABILITATION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEAK PHYSICAL THERAPY AND REHABILITATION LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578792370
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 PHYSICIANS BLVD
Provider Second Line Business Mailing Address:
STE D
Provider Business Mailing Address City Name:
ENNIS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-878-1200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 PHYSICIANS BLVD
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
ENNIS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-878-1200
Provider Business Practice Location Address Fax Number:
972-878-1202
Provider Enumeration Date:
07/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DILLARD
Authorized Official First Name:
JEANIE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
214-369-8855

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251S0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0019X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0086SL . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 206202801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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