Healthcare Provider Details

I. General information

NPI: 1790262715
Provider Name (Legal Business Name): PEAK THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 N FLEMING DR
FLAGSTAFF AZ
86004-6247
US

IV. Provider business mailing address

8380 N FLEMING DR
FLAGSTAFF AZ
86004-6247
US

V. Phone/Fax

Practice location:
  • Phone: 928-310-0947
  • Fax:
Mailing address:
  • Phone: 928-310-0947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6768
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number6768
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICIA ANNE NEW-JENKINS
Title or Position: PT,DPT
Credential: DPT
Phone: 928-310-0947