MEDICARE: PEAK MOTION, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	317434	OTHER	WA	LABOR & INDUSTRIES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588916894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK MOTION, PLLC

Provider Business Mailing Address
First Line	:	1905 SE 192ND AVE STE 109
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-7415
Country	:	US
Telephone Number	:	360-210-5440
Fax Number	:	360-210-7731

Provider Business Practice Location Address
First Line	:	1905 SE 192ND AVE STE 109
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-7415
Country	:	US
Telephone Number	:	360-210-5440
Fax Number	:	360-210-7731

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL DAVID TEATER
Credential	:	PT, DPT, OCS
Telephone Number	:	360-949-5845

Provider Enumeration Date	:	10/10/2012
Last Update Date	:	07/08/2024

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Directions to “PEAK MOTION, PLLC ” Practice Location

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