Healthcare Provider Details

I. General information

NPI: 1710413018
Provider Name (Legal Business Name): PEAK PT AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16522 KEYSTONE BLVD UNIT N
PARKER CO
80134-3303
US

IV. Provider business mailing address

16522 KEYSTONE BLVD UNIT N
PARKER CO
80134-3303
US

V. Phone/Fax

Practice location:
  • Phone: 954-549-3525
  • Fax: 303-840-7326
Mailing address:
  • Phone: 954-549-3525
  • Fax: 303-840-7326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberOT.0005018
License Number StateCO

VIII. Authorized Official

Name: MS. MELISSA CHRISTINE CEPEDA
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 954-549-3525