Healthcare Provider Details

I. General information

NPI: 1831572759
Provider Name (Legal Business Name): THE PEAK PHYSICAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 PROFESSIONAL PL STE 201
COLORADO SPRINGS CO
80904-8140
US

IV. Provider business mailing address

2955 PROFESSIONAL PL STE 201
COLORADO SPRINGS CO
80904-8140
US

V. Phone/Fax

Practice location:
  • Phone: 719-591-5545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number34408
License Number StateCO

VIII. Authorized Official

Name: TIMOTHY VAUGHN SANDELL
Title or Position: OWNER
Credential: M.D.
Phone: 719-591-5545